Provider Demographics
NPI:1740419811
Name:UPDIKE, SPENCER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:UPDIKE
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 1:34S 500 E 207
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1065
Mailing Address - Country:US
Mailing Address - Phone:801-521-8188
Mailing Address - Fax:
Practice Address - Street 1:18775 N REEMS RD STE 300C
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8647
Practice Address - Country:US
Practice Address - Phone:623-584-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77347111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice