Healthcare Provider Details

I. General information

NPI: 1316118185
Provider Name (Legal Business Name): SPENCER CALL ARCHIBALD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S HIGLEY RD SUITE 206
MESA AZ
85206-4000
US

IV. Provider business mailing address

19106 E MOCKINGBIRD DR
QUEEN CREEK AZ
85142-6872
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-9110
  • Fax:
Mailing address:
  • Phone: 480-371-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD7727
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: