Provider Demographics
NPI:1861465189
Name:SPENCER, DANIEL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANDREW
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 1:1501 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2800
Mailing Address - Country:US
Mailing Address - Phone:303-722-1115
Mailing Address - Fax:303-350-3952
Practice Address - Street 1:1501 S GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2800
Practice Address - Country:US
Practice Address - Phone:303-722-1115
Practice Address - Fax:303-350-3952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice