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General NPI Number Information
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NPI Number | 1568877207
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Entity Type | Individual
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Provider Name | SPENCER RYAN TERRY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 2122A DANVILLE RD SW
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City | DECATUR
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State | AL
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Zip | 35601-4617
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Country | US
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Telephone | 256-355-7552
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Fax |
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Provider Business Mailing Address
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Address Line | 466 HIGHWAY 67 S
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City | DECATUR
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State | AL
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Zip | 35603-6300
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6100
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License Number State | AL
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