Provider Demographics
NPI:1093867038
Name:SPENCER, PAULINE (DMD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 JOSHUA TREE LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3494
Mailing Address - Country:US
Mailing Address - Phone:832-285-2131
Mailing Address - Fax:
Practice Address - Street 1:503 DANCE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-4019
Practice Address - Country:US
Practice Address - Phone:979-345-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM28121223G0001X
TX25848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice