Provider Demographics
NPI:1215259429
Name:SPENCE, TERRY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:SPENCE
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 1:2103 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4401
Mailing Address - Country:US
Mailing Address - Phone:573-332-7223
Mailing Address - Fax:573-334-7379
Practice Address - Street 1:2103 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4401
Practice Address - Country:US
Practice Address - Phone:573-332-7223
Practice Address - Fax:573-334-7379
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0159241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27-1535914OtherTAX ID #