Healthcare Provider Details

I. General information

NPI: 1619168259
Provider Name (Legal Business Name): SPENCER DAVID WEED D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD STE 220
MODESTO CA
95355-3362
US

IV. Provider business mailing address

1317 OAKDALE RD STE 220
MODESTO CA
95355-3362
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4299
  • Fax: 209-526-4399
Mailing address:
  • Phone: 209-526-4299
  • Fax: 209-526-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: