MEDICARE: DR. GARY BREWSTER SPENCE DDS

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	FLON08758	FL

General Provider Information

NPI Number	:	1932117876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY BREWSTER SPENCE DDS

Provider Business Mailing Address
First Line	:	531 S CHICKASAW TR
Second Line	:	#255
City	:	ORLANDO
State	:	FL
Zip	:	32825-7803
Country	:	US
Telephone Number	:	407-277-3341
Fax Number	:	407-277-3341

Provider Business Practice Location Address
First Line	:	531 S CHICKASAW TR
Second Line	:	SUITE 255
City	:	ORLANDO
State	:	FL
Zip	:	32825-7803
Country	:	US
Telephone Number	:	407-277-3341
Fax Number	:	407-277-3341

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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