Provider Demographics
NPI:1568967966
Name:SPURGEON, JONATHAN (DMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SPURGEON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 MADISON ST STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5412
Mailing Address - Country:US
Mailing Address - Phone:931-291-6530
Mailing Address - Fax:
Practice Address - Street 1:2550 MADISON ST STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5412
Practice Address - Country:US
Practice Address - Phone:931-291-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice