Provider Demographics
NPI:1245340249
Name:SPENCER, MICHAEL DARWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DARWIN
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 1:1061 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4152
Mailing Address - Country:US
Mailing Address - Phone:904-355-5531
Mailing Address - Fax:904-791-9239
Practice Address - Street 1:1061 RIVERSIDE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4152
Practice Address - Country:US
Practice Address - Phone:904-355-5531
Practice Address - Fax:904-791-9239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice