Provider Demographics
NPI:1306829080
Name:SPENCER, GLYNN STEPHEN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLYNN
Middle Name:STEPHEN
Last Name:SPENCER
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:301 NE MULBERRY ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5818
Mailing Address - Country:US
Mailing Address - Phone:816-607-6000
Mailing Address - Fax:816-607-6001
Practice Address - Street 1:301 NE MULBERRY ST
Practice Address - Street 2:SUITE #201
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5818
Practice Address - Country:US
Practice Address - Phone:816-607-6000
Practice Address - Fax:816-607-6001
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2010-09-17
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Provider Licenses
StateLicense IDTaxonomies
MO20001612311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry