Provider Demographics
NPI:1326219684
Name:SPENCER, DENA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2843
Mailing Address - Country:US
Mailing Address - Phone:630-876-9200
Mailing Address - Fax:630-876-9201
Practice Address - Street 1:534 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2843
Practice Address - Country:US
Practice Address - Phone:630-876-9200
Practice Address - Fax:630-876-9201
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9176645Medicaid