Provider Demographics
NPI:1184888430
Name:SPALDING, BRETT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:SPALDING
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 1:515 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1534
Mailing Address - Country:US
Mailing Address - Phone:217-324-7900
Mailing Address - Fax:217-324-7929
Practice Address - Street 1:515 N MONROE ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1534
Practice Address - Country:US
Practice Address - Phone:217-324-7900
Practice Address - Fax:217-324-7929
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist