Provider Demographics
NPI:1255596714
Name:SPENCER, HOWARD RANDOLPH (DMD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:RANDOLPH
Last Name:SPENCER
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 1:625 SE 2ND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-734-6606
Mailing Address - Fax:561-734-6607
Practice Address - Street 1:625 SE 2ND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-734-6606
Practice Address - Fax:561-734-6607
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist