Provider Demographics
NPI:1376961482
Name:ELIZABETH D. SPENCE, D.M.D., P.C.
Entity Type:Organization
Organization Name:ELIZABETH D. SPENCE, D.M.D., P.C.
Other - Org Name:SMILE DOWNERS GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-541-3486
Mailing Address - Street 1:5149 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4615
Mailing Address - Country:US
Mailing Address - Phone:630-541-3486
Mailing Address - Fax:
Practice Address - Street 1:5149 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4615
Practice Address - Country:US
Practice Address - Phone:630-541-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0274451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty