Provider Demographics
NPI:1386252864
Name:TWADDLE, SPENCER B (DDS)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:B
Last Name:TWADDLE
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 1:231 E SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-3617
Mailing Address - Country:US
Mailing Address - Phone:660-582-2273
Mailing Address - Fax:
Practice Address - Street 1:231 E SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3617
Practice Address - Country:US
Practice Address - Phone:660-582-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020021695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist