Provider Demographics
NPI:1770615734
Name:SPENCER, DURWOOD (DDS)
Entity type:Individual
Prefix:DR
First Name:DURWOOD
Middle Name:
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 1:3000 MALL VIEW RD
Mailing Address - Street 2:SUITE C-71
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3057
Mailing Address - Country:US
Mailing Address - Phone:661-871-6872
Mailing Address - Fax:
Practice Address - Street 1:3000 MALL VIEW RD
Practice Address - Street 2:SUITE C-71
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3057
Practice Address - Country:US
Practice Address - Phone:661-871-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389481223G0001X
TX204221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice