MEDICARE: DR. SUZANNE ALLISON SPENCE WIILIAMS D.D.S.

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	1223G0001X	General Practice Dentistry	DN0012795	FL

General Provider Information

NPI Number	:	1669681714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE ALLISON SPENCE WIILIAMS D.D.S.

Provider Business Mailing Address
First Line	:	4195 NW FEDERAL HWY
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3623
Country	:	US
Telephone Number	:	772-692-2237
Fax Number	:	772-692-4234

Provider Business Practice Location Address
First Line	:	4195 NW FEDERAL HWY
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3623
Country	:	US
Telephone Number	:	772-692-2237
Fax Number	:	772-692-4234

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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