Provider Demographics
NPI:1821168337
Name:LUTH, SPENCER (DMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:LUTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 S EASTERN AVE
Mailing Address - Street 2:#101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7936
Mailing Address - Country:US
Mailing Address - Phone:702-456-0009
Mailing Address - Fax:702-458-0009
Practice Address - Street 1:9400 S EASTERN AVE
Practice Address - Street 2:#101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-7936
Practice Address - Country:US
Practice Address - Phone:702-456-0009
Practice Address - Fax:702-458-0009
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice