Provider Demographics
NPI:1306576780
Name:RICHARDS, SPENCER DYRENG (DMD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:DYRENG
Last Name:RICHARDS
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 1:1445 E 5600 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4537
Mailing Address - Country:US
Mailing Address - Phone:801-725-5989
Mailing Address - Fax:
Practice Address - Street 1:11020 N 5500 W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9643
Practice Address - Country:US
Practice Address - Phone:801-756-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12855796-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice