Provider Demographics
NPI:1346556040
Name:SPENCER, SHAMAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAMAINE
Middle Name:
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 1:8 MEDICAL CENTER RD
Mailing Address - Street 2:P.O. BOX 2606
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7086
Mailing Address - Country:US
Mailing Address - Phone:505-224-8718
Mailing Address - Fax:505-224-8737
Practice Address - Street 1:8 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-7086
Practice Address - Country:US
Practice Address - Phone:505-224-8718
Practice Address - Fax:505-224-8737
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist