Provider Demographics
NPI:1841493137
Name:SPENCE DENTAL, P.A.
Entity type:Organization
Organization Name:SPENCE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-543-0455
Mailing Address - Street 1:92 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-543-0455
Mailing Address - Fax:603-543-0455
Practice Address - Street 1:92 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-3180
Practice Address - Country:US
Practice Address - Phone:603-543-0455
Practice Address - Fax:603-543-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30319759Medicaid
VT1020376Medicaid