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NPI Code Detail

MEDICARE: SPENCER ALLEN

MEDICARE: SPENCER ALLEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistrySTUDENTWA

General Provider Information

NPI Number : 1215870589
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER ALLEN
Provider Business Mailing Address
First Line : 4476 W VAN GIESEN ST UNIT A
Second Line :
City : WEST RICHLAND
State : WA
Zip : 99353-5411
Country : US
Telephone Number : 509-967-3421
Fax Number :
Provider Business Practice Location Address
First Line : 4476 W VAN GIESEN ST UNIT A
Second Line :
City : WEST RICHLAND
State : WA
Zip : 99353-5411
Country : US
Telephone Number : 509-967-3421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ SPENCER ALLEN ” Practice Location

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