Provider Demographics
NPI:1245336130
Name:SPIVEY, BEN MAC-RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:MAC-RYAN
Last Name:SPIVEY
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 1:2130 SW 22ND PL
Mailing Address - Street 2:102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7065
Mailing Address - Country:US
Mailing Address - Phone:352-624-9600
Mailing Address - Fax:352-237-3564
Practice Address - Street 1:2130 SW 22ND PL
Practice Address - Street 2:102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7065
Practice Address - Country:US
Practice Address - Phone:352-624-9600
Practice Address - Fax:352-237-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice