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General NPI Number Information
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NPI Number | 1053113829
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Entity Type | Organization
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Legal Business Name | LAURA E. SPENCE, DMD, LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2201 5TH STREET HOLLOW RD STE 2
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City | BLOOMSBURG
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State | PA
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Zip | 17815-7757
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Country | US
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Telephone | 570-458-6731
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Fax |
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Provider Business Mailing Address
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Address Line | 274 MOORES HILL RD
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City | BERWICK
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State | PA
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Zip | 18603-6219
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Country | US
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Telephone | 570-854-4989
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LAURA ELYSE SPENCE
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Credential | DMD
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Telephone | 570-854-4989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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