Provider Demographics
NPI:1639241599
Name:SPENCE, DENNIS ROSS (DDS, MS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ROSS
Last Name:SPENCE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 412
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1952
Mailing Address - Country:US
Mailing Address - Phone:903-595-5186
Mailing Address - Fax:903-595-5240
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 412
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1952
Practice Address - Country:US
Practice Address - Phone:903-595-5186
Practice Address - Fax:903-595-5240
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1305898-05Medicaid
TX0808586-01Medicaid
TX1305898-04Medicaid
TX0808586-01Medicaid
TX1305898-05Medicaid
TX190007325Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX1305898-04Medicaid