Provider Demographics
NPI:1508481474
Name:BENSE, SPENCER ROSS (DMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ROSS
Last Name:BENSE
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 1:1100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1172
Mailing Address - Country:US
Mailing Address - Phone:570-297-2113
Mailing Address - Fax:570-297-3919
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1172
Practice Address - Country:US
Practice Address - Phone:570-297-2113
Practice Address - Fax:570-297-3919
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0041991223G0001X
PADS0429371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice