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1629150958 NPI number — ROBERT NELSON SPENCER D.D.S. M.S.

NPI Number: 1629150958
Health Care Provider/Practitioner: ROBERT NELSON SPENCER D.D.S. M.S.

Information about “1629150958” NPI (ROBERT NELSON SPENCER D.D.S. M.S.) exists in 1629150958 in HTML format HTML  |  1629150958 in plain Text format TXT  |  1629150958 in PDF (Portable Document Format) PDF  |  1629150958 in an XML format XML  formats.

NPI Number : 1629150958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629150958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPENCER",
    "FirstName": "ROBERT",
    "MiddleName": "NELSON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S. M.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 505",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CEDAR FALLS",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50613-0027",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "319-277-7121",
    "MailingAddressFaxNumber": "319-266-3778",
    "FirstLinePracticeLocationAddress": "703 N MAIN ST STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLES CITY",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50616-2126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "641-228-4821",
    "PracticeLocationAddressFaxNumber": "641-228-4822",
    "EnumerationDate": "10/19/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "6303",
        "LicenseNumberStateCode": "IA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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