Provider Demographics
NPI:1194928390
Name:MARRERO, SPENCER ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:ALEXANDER
Last Name:MARRERO
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 1:16400 SW HART RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3457
Mailing Address - Country:US
Mailing Address - Phone:503-649-7701
Mailing Address - Fax:
Practice Address - Street 1:16400 SW HART RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-3457
Practice Address - Country:US
Practice Address - Phone:503-649-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD60891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice