Organization
SPIKA DENTAL, INC.
Active
Other names
McGovern and Borin Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD CHARLES SPIKA DMD (PRESIDENT)
(253) 651-0705
Entity
Organization
Contact information
Practice address
312 W LINE ST, BISHOP, CA 93514-3413
(253) 651-0705
Mailing address
PO BOX 2185, MAMMOTH LAKES, CA 93546-2185
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
102998
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578603627
NPI
CA
01
—
1841345444
NPI
CA
Enumeration date
08/09/2018
Last updated
08/09/2018
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