Provider Demographics
NPI:1801203450
Name:SPENCER GORDY DDS PA
Entity Type:Organization
Organization Name:SPENCER GORDY DDS PA
Other - Org Name:DENTAL DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-733-1677
Mailing Address - Street 1:550 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5402
Mailing Address - Country:US
Mailing Address - Phone:501-329-8754
Mailing Address - Fax:
Practice Address - Street 1:550 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5402
Practice Address - Country:US
Practice Address - Phone:501-329-8754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty