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NPI Code Detail

MEDICARE: BRIAN J SPENCE

MEDICARE: BRIAN J SPENCE
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
1122300000XDentist23853TX

General Provider Information

NPI Number : 1659537843
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN J SPENCE
Provider Business Mailing Address
First Line : 4011 S TEXAS AVE
Second Line :
City : BRYAN
State : TX
Zip : 77802-4022
Country : US
Telephone Number : 979-846-0353
Fax Number :
Provider Business Practice Location Address
First Line : 4011 S TEXAS AVE
Second Line :
City : BRYAN
State : TX
Zip : 77802-4022
Country : US
Telephone Number : 979-846-0353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2008
Last Update Date : 08/06/2008

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Directions to “ BRIAN J SPENCE ” Practice Location

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