Provider Demographics
NPI:1609234343
Name:SPENCER, MICHELLE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3894 ROBINA AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1499
Mailing Address - Country:US
Mailing Address - Phone:248-496-7447
Mailing Address - Fax:248-439-2900
Practice Address - Street 1:3894 ROBINA AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1499
Practice Address - Country:US
Practice Address - Phone:248-496-7447
Practice Address - Fax:248-439-2900
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017545124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist