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General NPI Number Information
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NPI Number | 1679880124
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Entity Type | Organization
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Legal Business Name | SPENCER AND SPENCER PEDIATRIC DENTISTRY, DDS, PC
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Dates
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Enumeration Date | 09/04/2010
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Last Update Date | 09/04/2010
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Provider Practice Location Address
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Address Line | 301 NE MULBERRY ST SUITE #201
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5818
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Country | US
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Telephone | 816-373-2052
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NE MULBERRY ST SUITE #201
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5818
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Country | US
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Telephone | 816-373-2052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLYNN STEPHEN SPENCER
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Credential | D.D.S.
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Telephone | 816-607-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2000161231
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License Number State | MO
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