Provider Demographics
NPI:1871119487
Name:DALEY, SPENCER (DDS)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:DALEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 LITTLE RAVEN ST APT 517
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7204
Mailing Address - Country:US
Mailing Address - Phone:507-993-3196
Mailing Address - Fax:
Practice Address - Street 1:10442 TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6094
Practice Address - Country:US
Practice Address - Phone:303-410-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist