Provider Demographics
NPI:1447463328
Name:SPENCER, AMY SANDERS (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SANDERS
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MELTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4120
Mailing Address - Country:US
Mailing Address - Phone:228-762-9250
Mailing Address - Fax:228-762-1785
Practice Address - Street 1:2910 MELTON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4120
Practice Address - Country:US
Practice Address - Phone:228-762-9250
Practice Address - Fax:228-762-1785
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3339-051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice