Provider Demographics
NPI:1508022682
Name:SPENCER, REBEKAH E (DMD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:E
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5417
Mailing Address - Country:US
Mailing Address - Phone:503-235-0054
Mailing Address - Fax:503-235-7258
Practice Address - Street 1:6200 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5417
Practice Address - Country:US
Practice Address - Phone:503-235-0054
Practice Address - Fax:503-235-7258
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist