Provider Demographics
NPI:1578863734
Name:SPENCER LUKE DMD, INC.
Entity Type:Organization
Organization Name:SPENCER LUKE DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-596-3000
Mailing Address - Street 1:1011 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-1600
Mailing Address - Country:US
Mailing Address - Phone:801-596-3000
Mailing Address - Fax:801-596-8887
Practice Address - Street 1:1011 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-1600
Practice Address - Country:US
Practice Address - Phone:801-596-3000
Practice Address - Fax:801-596-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT63217271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty