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General NPI Number Information
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NPI Number | 1740419811
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Entity Type | Individual
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Provider Name | SPENCER UPDIKE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 18775 N REEMS RD STE 300C
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City | SURPRISE
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State | AZ
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Zip | 85374-8647
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Country | US
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Telephone | 623-584-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 34S 500 E 207
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1065
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Country | US
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Telephone | 801-521-8188
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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 | 7734711
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License Number State | UT
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