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General NPI Number Information
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NPI Number | 1003198680
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Entity Type | Individual
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Provider Name | SPENCER JOHN SHOFF DMD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1200 HAMPSHIRE ST
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City | QUINCY
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State | IL
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Zip | 62301-3109
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Country | US
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Telephone | 217-228-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 208 WILLIAM ST
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City | EAST PEORIA
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State | IL
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Zip | 61611-1939
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Country | US
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Telephone | 912-650-3035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021002622
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License Number State | IL
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