Provider Demographics
NPI:1619187390
Name:MAUSETH, SPENCER E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:E
Last Name:MAUSETH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:859 S YELLOWSTONE HWY
Mailing Address - Street 2:SUITE #1202
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5293
Mailing Address - Country:US
Mailing Address - Phone:208-552-5439
Mailing Address - Fax:208-552-5440
Practice Address - Street 1:859 S YELLOWSTONE HWY
Practice Address - Street 2:SUITE #1202
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5293
Practice Address - Country:US
Practice Address - Phone:208-552-5439
Practice Address - Fax:208-552-5440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADDS619861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry