Provider Demographics
NPI:1417440850
Name:NICE, SPENCER LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LEE
Last Name:NICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 COLUMBIA ST STE 870
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8539
Mailing Address - Country:US
Mailing Address - Phone:619-850-2550
Mailing Address - Fax:
Practice Address - Street 1:1230 COLUMBIA ST STE 870
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8539
Practice Address - Country:US
Practice Address - Phone:619-858-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857968122300000X
CA105021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1255647525OtherDR. EDWARD ROBERTS III