Healthcare Provider Details

I. General information

NPI: 1326609108
Provider Name (Legal Business Name): SPENSER AUSTIN DURST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MONROE AVE
FORT EUSTIS VA
23604-5005
US

IV. Provider business mailing address

300 CORVETTE DR
WILLIAMSBURG VA
23185-5367
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-8016
  • Fax:
Mailing address:
  • Phone: 512-888-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35143
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: