Provider Demographics
NPI:1265010870
Name:SPENCE, LAURA ELYSE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELYSE
Last Name:SPENCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MOORES HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-6219
Mailing Address - Country:US
Mailing Address - Phone:570-854-4989
Mailing Address - Fax:
Practice Address - Street 1:2201 5TH STREET HOLLOW RD STE 2
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-7757
Practice Address - Country:US
Practice Address - Phone:570-458-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty