Provider Demographics
NPI:1043467657
Name:KRUSE, SPENCER JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JAMES
Last Name:KRUSE
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 1:6425 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2158
Mailing Address - Country:US
Mailing Address - Phone:317-255-2941
Mailing Address - Fax:317-255-1656
Practice Address - Street 1:6425 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2158
Practice Address - Country:US
Practice Address - Phone:317-255-2941
Practice Address - Fax:317-255-1656
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist