Provider Demographics
NPI:1922598275
Name:JULIE C. SPIVEY, D.M.D., P.L.L.C.
Entity Type:Organization
Organization Name:JULIE C. SPIVEY, D.M.D., P.L.L.C.
Other - Org Name:LAKE NORMAN PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-540-6928
Mailing Address - Street 1:1716 WILMORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4343
Mailing Address - Country:US
Mailing Address - Phone:205-540-6928
Mailing Address - Fax:
Practice Address - Street 1:407 N NC 16 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-6003
Practice Address - Country:US
Practice Address - Phone:205-540-6928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10515261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental