Provider Demographics
NPI:1326039660
Name:SPENCER, WENDY JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:JEAN
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 1:5501 BASIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3952
Mailing Address - Country:US
Mailing Address - Phone:541-273-1810
Mailing Address - Fax:
Practice Address - Street 1:5501 BASIN VIEW DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3952
Practice Address - Country:US
Practice Address - Phone:541-273-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist