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General NPI Number Information
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NPI Number | 1609661636
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Entity Type | Individual
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Provider Name | SPENCER RAY DMD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 5069 W 13400 S STE 200
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City | RIVERTON
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State | UT
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Zip | 84096-6602
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Country | US
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Telephone | 385-766-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 4426 W HILL SHADOW WAY
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City | HERRIMAN
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State | UT
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Zip | 84096-4822
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Country | US
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Telephone | 480-336-0663
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 14213335-9926
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License Number State | UT
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