| Spencer Dental | |
|
5002 Airport Rd Nw Unit 130 Roanoke VA 24012-1607 | |
| (770) 916-5031 | |
| Not Available |
| Full Name | Spencer Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5002 Airport Rd Nw, Roanoke, Virginia |
| Authorized Official Name and Position | Michelle Jacomino (DIRECTOR OF PAYOR RELATIONS) |
| Authorized Official Contact | 7709165036 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spencer Dental 1090 Northchase Pkwy Se Suite 150 Marietta GA 30067-6405 | Spencer Dental 5002 Airport Rd Nw Unit 130 Roanoke VA 24012-1607 Ph: (770) 916-5031 |
| NPI Number | 1669871968 |
|---|---|
| Provider Enumeration Date | 08/22/2014 |
| Last Update Date | 05/27/2022 |
| Certification Date | 05/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669871968 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (NU) | Secondary |
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (NU) | Secondary |
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