Active NPI
Julie Custred Spivey, DMD
- Pediatric Dentistry
- Charlotte, NC
National Provider Identifier
1396057006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 10515
- Practice address
- 4901 N Tryon St
Unit a
Charlotte, NC 28213-7076 - Phone
- (704) 921-0204
- NPI assigned
- Jul 10, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5764 | AL | |
| Pediatric Dentistry | 1223P0221X | 10515 | NC | Primary |
Addresses
Primary practice location
4901 N Tryon St
Unit a
Charlotte, NC 28213-7076
Mailing address
4901 N Tryon St
Unit a
Charlotte, NC 28213-7076
Phone (704) 921-0204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10515 | NC | MD | Physical Therapist |
| 5764 | AL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1396057006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4901 N TRYON ST",
"address_2": "UNIT A",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282137076",
"telephone_number": "704-921-0204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 N TRYON ST",
"address_2": "UNIT A",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282137076",
"telephone_number": "704-921-0204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVEY",
"first_name": "JULIE",
"middle_name": "CUSTRED",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-10",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "5764",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NC",
"license": "10515",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.