Provider Demographics
NPI:1659032431
Name:DYKMAN, SPENCER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:C
Last Name:DYKMAN
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 1:209 TURTLE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5343
Mailing Address - Country:US
Mailing Address - Phone:208-608-8252
Mailing Address - Fax:
Practice Address - Street 1:4171 CRESCENT DR STE 102
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3645
Practice Address - Country:US
Practice Address - Phone:314-200-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist