Provider Demographics
NPI:1003198680
Name:SHOFF, SPENCER JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JOHN
Last Name:SHOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GRAND OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2848
Mailing Address - Country:US
Mailing Address - Phone:912-650-3035
Mailing Address - Fax:
Practice Address - Street 1:665 SCRANTON RD STE 4
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1975
Practice Address - Country:US
Practice Address - Phone:912-689-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112921223P0300X
GADN0155681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics