Healthcare Provider Details

I. General information

NPI: 1376766261
Provider Name (Legal Business Name): SPENCER H OWADES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST SE SUITE 150
LOVELAND CO
80537-6419
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-461-8942
  • Fax: 970-292-1538
Mailing address:
  • Phone: 970-350-4606
  • Fax: 970-350-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCSDT-11
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16236
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number202099
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: