Provider Demographics
NPI:1477991065
Name:GORDY, SPENCER PRESTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:PRESTON
Last Name:GORDY
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 1:1623 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1415
Mailing Address - Country:US
Mailing Address - Phone:501-733-1677
Mailing Address - Fax:
Practice Address - Street 1:550 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5402
Practice Address - Country:US
Practice Address - Phone:501-329-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice