=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629150958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT NELSON SPENCER D.D.S. M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 N MAIN ST STE 2
-----------------------------------------------------
City | CHARLES CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50616-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-228-4821
-----------------------------------------------------
Fax | 641-228-4822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 505
-----------------------------------------------------
City | CEDAR FALLS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50613-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-277-7121
-----------------------------------------------------
Fax | 319-266-3778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 6303
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------