Provider Demographics
NPI:1578675237
Name:SPENCER, CLARK ALLISON (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ALLISON
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 NORTH FOURTH STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605
Mailing Address - Country:US
Mailing Address - Phone:903-757-0534
Mailing Address - Fax:903-757-7461
Practice Address - Street 1:2904 NORTH FOURTH STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-757-0534
Practice Address - Fax:903-757-7461
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist