Provider Demographics
NPI:1669917340
Name:S. JILL SPURLIN, DMD, LLC
Entity type:Organization
Organization Name:S. JILL SPURLIN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SPURLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-475-2624
Mailing Address - Street 1:510 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2031
Mailing Address - Country:US
Mailing Address - Phone:334-475-2624
Mailing Address - Fax:334-475-2984
Practice Address - Street 1:510 E LEE ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2031
Practice Address - Country:US
Practice Address - Phone:334-475-2624
Practice Address - Fax:334-475-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20134CMedicare UPIN