Provider Demographics
NPI:1245749910
Name:SCHNEIDER, SPENCER LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LEE
Last Name:SCHNEIDER
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 1:2330 KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3406
Mailing Address - Country:US
Mailing Address - Phone:847-310-2988
Mailing Address - Fax:
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 302
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:303-316-7846
Practice Address - Fax:303-316-7848
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002032151223X0400X
IL019.0309221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics