Provider Demographics
NPI:1902963770
Name:SPINK, BRUCE TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TAYLOR
Last Name:SPINK
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 1:4005 CROSSHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5229
Mailing Address - Country:US
Mailing Address - Phone:205-967-8555
Mailing Address - Fax:205-968-0202
Practice Address - Street 1:4005 CROSSHAVEN DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-5229
Practice Address - Country:US
Practice Address - Phone:205-967-8555
Practice Address - Fax:205-968-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice