Provider Demographics
NPI:1316782832
Name:SPURGEON MANUEL, ERICKSON
Entity type:Individual
Prefix:DR
First Name:ERICKSON
Middle Name:
Last Name:SPURGEON MANUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 LA DOVA WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2525
Mailing Address - Country:US
Mailing Address - Phone:240-701-7142
Mailing Address - Fax:
Practice Address - Street 1:10999 RED RUN BLVD STE 208
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3262
Practice Address - Country:US
Practice Address - Phone:410-630-0000
Practice Address - Fax:410-630-0001
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist