MEDICARE: DR. SPENCER REID FAIR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9912	SC

General Provider Information

NPI Number	:	1164099479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER REID FAIR DMD

Provider Business Mailing Address
First Line	:	327 W TREMONT AVE APT 134
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6159
Country	:	US
Telephone Number	:	859-421-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2337
Country	:	US
Telephone Number	:	803-902-4518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2021
Last Update Date	:	06/06/2021

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