Healthcare Provider Details

I. General information

NPI: 1912367673
Provider Name (Legal Business Name): SPENCER HUA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S WELLS RD STE 225
VENTURA CA
93004-1382
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-659-0560
  • Fax: 805-647-7164
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number102176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: