Provider Demographics
NPI:1407270135
Name:ANDERSON, SPENCER JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JAMES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:402-350-3536
Mailing Address - Fax:
Practice Address - Street 1:1116 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-732-7946
Practice Address - Fax:559-732-9621
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery