Healthcare Provider Details

I. General information

NPI: 1427017003
Provider Name (Legal Business Name): SPENCER SEAN STCYR D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 OKLAHOMA RD
ELDERSBURG MD
21784-6620
US

IV. Provider business mailing address

5973 CECIL WAY
ELDERSBURG MD
21784-8576
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-0101
  • Fax: 410-795-0165
Mailing address:
  • Phone: 410-795-0101
  • Fax: 410-795-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12837
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: