Provider Demographics
NPI:1679880124
Name:SPENCER AND SPENCER PEDIATRIC DENTISTRY, DDS, PC
Entity Type:Organization
Organization Name:SPENCER AND SPENCER PEDIATRIC DENTISTRY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLYNN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-607-6000
Mailing Address - Street 1:301 NE MULBERRY ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5818
Mailing Address - Country:US
Mailing Address - Phone:816-373-2052
Mailing Address - Fax:
Practice Address - Street 1:301 NE MULBERRY ST
Practice Address - Street 2:SUITE #201
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5818
Practice Address - Country:US
Practice Address - Phone:816-373-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001612311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty