Healthcare Provider Details

I. General information

NPI: 1013320688
Provider Name (Legal Business Name): TEDDY H SPENCE, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3897 MAIN ST
CHINCOTEAGUE ISLAND VA
23336-1809
US

IV. Provider business mailing address

3897 MAIN ST
CHINCOTEAGUE ISLAND VA
23336-1809
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-5116
  • Fax: 757-336-2227
Mailing address:
  • Phone: 757-336-5116
  • Fax: 757-336-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005191
License Number StateVA

VIII. Authorized Official

Name: ELLEN KELLAM SPENCE
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-336-5116