Provider Demographics
NPI:1730472101
Name:SPENCER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SPENCER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SECTARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURAN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-732-1012
Mailing Address - Street 1:9060 HARMONY DR STE D
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6253
Mailing Address - Country:US
Mailing Address - Phone:405-732-1012
Mailing Address - Fax:405-733-8296
Practice Address - Street 1:9060 HARMONY DR STE D
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6253
Practice Address - Country:US
Practice Address - Phone:405-732-1012
Practice Address - Fax:405-733-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty