| Spencer Dental | |
|
400c Southpark Blvd Colonial Heights VA 23834-2974 | |
| (678) 904-5665 | |
| (678) 904-5669 |
| Full Name | Spencer Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 400c Southpark Blvd, Colonial Heights, Virginia |
| Authorized Official Name and Position | Gail Darden (MANAGER OF CREDENTIALING) |
| Authorized Official Contact | 7709168143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spencer Dental 210 Interstate North Pkwy Se Ste 300 Atlanta GA 30339-2233 Ph: (770) 916-9000 | Spencer Dental 400c Southpark Blvd Colonial Heights VA 23834-2974 Ph: (678) 904-5665 |
| NPI Number | 1255418331 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 01/18/2024 |
| Certification Date | 01/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255418331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | () | Secondary |
| 1223G0001X | Dentist - General Practice | () | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | () | Secondary |
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