Provider Demographics
NPI:1730269291
Name:SPIVEY, MARK HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JAMES COLEMAN DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3109
Mailing Address - Country:US
Mailing Address - Phone:361-572-3055
Mailing Address - Fax:361-572-0281
Practice Address - Street 1:202 JAMES COLEMAN DR
Practice Address - Street 2:SUITE E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3109
Practice Address - Country:US
Practice Address - Phone:361-572-3055
Practice Address - Fax:361-572-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice