Provider Demographics
NPI:1174699938
Name:SPENDLOVE, BRIAN WARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WARD
Last Name:SPENDLOVE
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 1:753 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2427
Mailing Address - Country:US
Mailing Address - Phone:435-789-3312
Mailing Address - Fax:
Practice Address - Street 1:753 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2427
Practice Address - Country:US
Practice Address - Phone:435-789-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139801-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice