Provider Demographics
NPI:1629232061
Name:SPENCER, STEPHEN (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SPENCER
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 1:339 MCCASLIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2914
Mailing Address - Country:US
Mailing Address - Phone:303-673-0500
Mailing Address - Fax:303-673-0505
Practice Address - Street 1:339 MCCASLIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2914
Practice Address - Country:US
Practice Address - Phone:303-673-0500
Practice Address - Fax:303-673-0505
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist