Provider Demographics
NPI:1831313089
Name:POPE, DALE SPENCER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:SPENCER
Last Name:POPE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:SPENCER
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19815 GOVERNORS HIGHWAY
Mailing Address - Street 2:ORTHODONTIC ASSOCIATES LTD SUITE 1
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422
Mailing Address - Country:US
Mailing Address - Phone:708-799-0060
Mailing Address - Fax:708-799-8765
Practice Address - Street 1:19815 GOVERNORS HIGHWAY
Practice Address - Street 2:ORTHODONTIC ASSOCIATES LTD SUITE 1
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-799-0060
Practice Address - Fax:708-799-8765
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics