Provider Demographics
NPI:1932117876
Name:SPENCE, GARY BREWSTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BREWSTER
Last Name:SPENCE
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 1:531 S CHICKASAW TR
Mailing Address - Street 2:#255
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7803
Mailing Address - Country:US
Mailing Address - Phone:407-277-3341
Mailing Address - Fax:407-277-3341
Practice Address - Street 1:531 S CHICKASAW TR
Practice Address - Street 2:SUITE 255
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7803
Practice Address - Country:US
Practice Address - Phone:407-277-3341
Practice Address - Fax:407-277-3341
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLON08758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist