Organization
GW SPENCER, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD W SPENCER DDS (OWNER)
(660) 826-3571
Entity
Organization
Contact information
Practice address
1716 W 11TH ST, SEDALIA, MO 65301-5221
(660) 826-3571
(660) 826-3051
Mailing address
1716 W 11TH ST, SEDALIA, MO 65301-5221
(660) 826-3571
(660) 826-3051
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11661
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11661
STATE LICENSE NUMBER
MO
Enumeration date
04/29/2008
Last updated
04/30/2008
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