Healthcare Provider Details

I. General information

NPI: 1508786120
Provider Name (Legal Business Name): JACOB SPENCER DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAKE SPENCER

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

7611 HIGH DR
PRAIRIE VILLAGE KS
66208-3643
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026020394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: