Provider Demographics
NPI:1073680344
Name:SPICER, DOUGLAS JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:SPICER
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 1:411 POPLAR STREET
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022
Mailing Address - Country:US
Mailing Address - Phone:712-243-6545
Mailing Address - Fax:712-243-9739
Practice Address - Street 1:411 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022
Practice Address - Country:US
Practice Address - Phone:712-243-6545
Practice Address - Fax:712-243-9739
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA055931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0070102Medicaid