Provider Demographics
NPI:1770860173
Name:SPRUCE DENTAL
Entity type:Organization
Organization Name:SPRUCE DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-605-0610
Mailing Address - Street 1:939 EAST PARK ROW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010
Mailing Address - Country:US
Mailing Address - Phone:817-987-1293
Mailing Address - Fax:817-987-1297
Practice Address - Street 1:939 E. PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010
Practice Address - Country:US
Practice Address - Phone:817-987-1293
Practice Address - Fax:817-987-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty