Provider Demographics
NPI:1306460845
Name:SPENCER, DANIEL EMERSON (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EMERSON
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1009
Mailing Address - Country:US
Mailing Address - Phone:815-953-1655
Mailing Address - Fax:
Practice Address - Street 1:330 VERMONT ST STE 100
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2700
Practice Address - Country:US
Practice Address - Phone:217-222-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0326021223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice