Healthcare Provider Details

I. General information

NPI: 1417977158
Provider Name (Legal Business Name): TEDDY HENRY SPENCE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TEDDY H SPENCE DDS

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MAIN ST
EXMORE VA
23350-4736
US

IV. Provider business mailing address

3060 MAIN ST PO BOX 819
EXMORE VA
23350-4736
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-3313
  • Fax: 757-442-9677
Mailing address:
  • Phone: 757-442-3313
  • Fax: 757-442-9677

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:
Title or Position:
Credential:
Phone: