Provider Demographics
NPI:1770649006
Name:SPENCER, STEPHEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:SPENCER
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 1:516 KINGLET CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3846
Mailing Address - Country:US
Mailing Address - Phone:406-727-6394
Mailing Address - Fax:
Practice Address - Street 1:912 13TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4406
Practice Address - Country:US
Practice Address - Phone:406-761-3368
Practice Address - Fax:406-761-4039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice