Provider Demographics
NPI:1578916730
Name:SPENCER, BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:SPENCER
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 1:3104 S DAY ST
Mailing Address - Street 2:APT 307
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3959
Mailing Address - Country:US
Mailing Address - Phone:425-681-5485
Mailing Address - Fax:
Practice Address - Street 1:3130 E MADISON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4264
Practice Address - Country:US
Practice Address - Phone:206-323-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60665106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist