Healthcare Provider Details

I. General information

NPI: 1871225680
Provider Name (Legal Business Name): COLIN RICHARD SPENCER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ANCHORAGE RD
WARSAW IN
46580
US

IV. Provider business mailing address

901 ANCHORAGE RD
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-385-3146
  • Fax: 866-251-8293
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-667-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number10274
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12014702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: