Provider Demographics
NPI:1356561245
Name:SPENCER, WARREN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:LEE
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 1:994 DOUGLAS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2068
Mailing Address - Country:US
Mailing Address - Phone:407-682-5757
Mailing Address - Fax:407-682-9017
Practice Address - Street 1:994 DOUGLAS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2068
Practice Address - Country:US
Practice Address - Phone:407-682-5757
Practice Address - Fax:407-682-9017
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice