Provider Demographics
NPI:1669760823
Name:BJARNASON, SPENCER (DMD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:BJARNASON
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 1:3622 WILLIAMS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2508
Mailing Address - Country:US
Mailing Address - Phone:512-948-7624
Mailing Address - Fax:512-948-7627
Practice Address - Street 1:3622 WILLIAMS DR STE 3
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2508
Practice Address - Country:US
Practice Address - Phone:512-948-7624
Practice Address - Fax:512-948-7627
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27220122300000X, 1223E0200X
NC105091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist