Provider Demographics
NPI:1063632164
Name:SPENCE, DEBRA J (RDH)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 S 88TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9461
Mailing Address - Country:US
Mailing Address - Phone:303-665-1281
Mailing Address - Fax:303-665-1281
Practice Address - Street 1:1068 S 88TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9461
Practice Address - Country:US
Practice Address - Phone:303-665-1281
Practice Address - Fax:303-665-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201230124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist