Healthcare Provider Details

I. General information

NPI: 1629125786
Provider Name (Legal Business Name): SPENCER S HODNETT DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16143 LANCASTER HWY SUITE 103
CHARLOTTE NC
28277
US

IV. Provider business mailing address

16143 LANCASTER HWY SUITE 103
CHARLOTTE NC
28277
US

V. Phone/Fax

Practice location:
  • Phone: 704-543-5000
  • Fax: 704-543-5006
Mailing address:
  • Phone: 704-543-5000
  • Fax: 704-543-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8358
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: