Provider Demographics
NPI:1396057006
Name:SPIVEY, JULIE CUSTRED (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CUSTRED
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 N TRYON ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7076
Mailing Address - Country:US
Mailing Address - Phone:704-921-0204
Mailing Address - Fax:
Practice Address - Street 1:4901 N TRYON ST
Practice Address - Street 2:UNIT A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7076
Practice Address - Country:US
Practice Address - Phone:704-921-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57641223G0001X
NC105151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice