Provider Demographics
NPI:1285933127
Name:SPENCER, MARGARET LILLIAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:LILLIAN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:LILLIAN
Other - Last Name:SPENCER-GROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:236 S 3RD ST # 294
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3618
Mailing Address - Country:US
Mailing Address - Phone:970-417-9781
Mailing Address - Fax:970-249-1344
Practice Address - Street 1:226 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4234
Practice Address - Country:US
Practice Address - Phone:970-249-4746
Practice Address - Fax:970-249-1344
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200841124Q00000X
CODH000200841124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist