Healthcare Provider Details

I. General information

NPI: 1720214455
Provider Name (Legal Business Name): SPENCER JAMES CAMPBELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SPACE CENTER DR
COLORADO SPRINGS CO
80915-2445
US

IV. Provider business mailing address

8842 STONY CREEK DR
COLORADO SPRINGS CO
80924-8132
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-8922
  • Fax:
Mailing address:
  • Phone: 971-212-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00202351
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: