Provider Demographics
NPI:1619933603
Name:SPURGEON DENTAL PC
Entity Type:Organization
Organization Name:SPURGEON DENTAL PC
Other - Org Name:PRESCOTT DENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-445-2440
Mailing Address - Street 1:222 S SUMMIT AVE
Mailing Address - Street 2:#2
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303
Mailing Address - Country:US
Mailing Address - Phone:928-445-2440
Mailing Address - Fax:928-778-4240
Practice Address - Street 1:222 S SUMMIT AVE
Practice Address - Street 2:#2
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303
Practice Address - Country:US
Practice Address - Phone:928-445-2440
Practice Address - Fax:928-778-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty