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General NPI Number Information
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NPI Number | 1093000150
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Entity Type | Individual
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Provider Name | SPENCER MATTHEW LEE DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | UNIT 3214 BOX DENTAL
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City | APO
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State | AE
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Zip | 09094-3214
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Country | US
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Telephone | 314-479-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 86TH DENTAL SQUADRON SGD UNIT 59
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City | APO
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State | AE
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Zip | 09094
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Country | US
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Telephone |
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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 | D008197
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License Number State | AZ
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