# TEDDY H SPENCE, DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Island Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013320688
- **Authorized official:** ELLEN KELLAM SPENCE (OFFICE MANAGER)
- **Authorized official phone:** (757) 336-5116

## Contact information

- **Practice address:** 3897 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-1809
- **Practice address phone:** (757) 336-5116
- **Practice address fax:** (757) 336-2227
- **Mailing address:** 3897 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-1809
- **Mailing address phone:** (757) 336-5116
- **Mailing address fax:** (757) 336-2227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401005191 | VA | Yes |

## Other

- **Enumeration date:** 06/11/2014
- **Last updated:** 06/11/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0401005191 | DENTAL LICENSE | VA |
| 01 | — | 1417977158 | NPI | VA |
| 05 | — | 2136095645751 | — | VA |