Healthcare Provider Details

I. General information

NPI: 1821135385
Provider Name (Legal Business Name): RICHARD OLIVER SPENCER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 E BARSTOW AVE SUITE 102
FRESNO CA
93710-6039
US

IV. Provider business mailing address

347 E BARSTOW AVE SUITE 102
FRESNO CA
93710-6039
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-7789
  • Fax: 559-222-8761
Mailing address:
  • Phone: 559-222-7789
  • Fax: 559-222-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: