Provider Demographics
NPI:1386740686
Name:SPIVEY, THOMAS MATTHEWS (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEWS
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:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-0387
Mailing Address - Country:US
Mailing Address - Phone:479-963-2292
Mailing Address - Fax:479-963-3501
Practice Address - Street 1:20 E SHORT MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-3338
Practice Address - Country:US
Practice Address - Phone:479-963-2292
Practice Address - Fax:479-963-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice