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Organization
TEDDY H SPENCE, DDS, PLLC
Active
Organization
TEDDY H SPENCE, DDS, PLLC
Active
Other names
Island Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN KELLAM SPENCE (OFFICE MANAGER)
(757) 336-5116
Entity
Organization
Contact information
Practice address
3897 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-1809
(757) 336-5116
(757) 336-2227
Mailing address
3897 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-1809
(757) 336-5116
(757) 336-2227
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401005191
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401005191
DENTAL LICENSE
VA
01
—
1417977158
NPI
VA
05
—
2136095645751
—
VA
Enumeration date
06/11/2014
Last updated
06/11/2014
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