Provider Demographics
NPI:1538600382
Name:SPRADLEY, FREDERICK L (DDS AND MSD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:SPRADLEY
Suffix:
Gender:M
Credentials:DDS AND MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 BARWICK DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1500
Mailing Address - Country:US
Mailing Address - Phone:817-294-5021
Mailing Address - Fax:817-294-9310
Practice Address - Street 1:4763 BARWICK DR
Practice Address - Street 2:SUITE 107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1500
Practice Address - Country:US
Practice Address - Phone:817-294-5021
Practice Address - Fax:817-294-9310
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics