Individual
GREGORY KEITH SPACKMAN
Active
Individual
GREGORY KEITH SPACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MBA
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17454
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126780805
MEDICAL DENTAL
TX
05
—
126785803
—
TX
Enumeration date
07/28/2005
Last updated
01/28/2014
Update your record
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