Provider Demographics
NPI:1023634433
Name:AMSTRUP, SPENCER MARGARET (DDS)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:MARGARET
Last Name:AMSTRUP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 EDGEMONT BLVD N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2655
Mailing Address - Country:US
Mailing Address - Phone:612-275-8035
Mailing Address - Fax:
Practice Address - Street 1:5237 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3103
Practice Address - Country:US
Practice Address - Phone:763-536-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND146361223G0001X
IADDS-097881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice