Provider Demographics
NPI:1467053876
Name:SPRADLIN, PAUL GLENN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GLENN
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 E MAIN ST UNIT 228
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1289
Mailing Address - Country:US
Mailing Address - Phone:606-923-0755
Mailing Address - Fax:
Practice Address - Street 1:10389 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7414
Practice Address - Country:US
Practice Address - Phone:813-304-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist