Provider Demographics
NPI:1346466984
Name:SPENCER, MARYLOUIS NAKHLEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYLOUIS
Middle Name:NAKHLEH
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 1:1750 E PALOMAR ST
Mailing Address - Street 2:SUITE,3
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3731
Mailing Address - Country:US
Mailing Address - Phone:619-216-8668
Mailing Address - Fax:619-216-8638
Practice Address - Street 1:1750 E PALOMAR ST
Practice Address - Street 2:SUITE,3
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3731
Practice Address - Country:US
Practice Address - Phone:619-216-8668
Practice Address - Fax:619-216-8638
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice