Provider Demographics
NPI:1124345061
Name:SPENCER - FULLER, JOY HATHAWAY (DDS)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:HATHAWAY
Last Name:SPENCER - FULLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S KING ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3918
Mailing Address - Country:US
Mailing Address - Phone:703-771-8500
Mailing Address - Fax:703-771-9541
Practice Address - Street 1:706 S KING ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3918
Practice Address - Country:US
Practice Address - Phone:703-771-8500
Practice Address - Fax:703-771-9541
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist