Teddy H Spence, DDS, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401005191 Issued in VA

Legal business name

TEDDY H SPENCE, DDS, PLLC

Doing business as

Island Dental

Practice address

3897 Main St
Chincoteague Island, VA 23336-1809

Phone

(757) 336-5116

Fax

(757) 336-2227

NPI assigned

Jun 11, 2014

Last updated

Jun 11, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ellen Kellam Spence

Title

Office Manager

Phone

(757) 336-5116

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Island Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William W Baczek, DDS

  • Dentist
  • Ventura, CA
  • NPI 1215951892

  General Practice

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1013320688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3897 MAIN ST",
            "city": "CHINCOTEAGUE ISLAND",
            "state": "VA",
            "postal_code": "233361809",
            "telephone_number": "757-336-5116",
            "fax_number": "757-336-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3897 MAIN ST",
            "city": "CHINCOTEAGUE ISLAND",
            "state": "VA",
            "postal_code": "233361809",
            "telephone_number": "757-336-5116",
            "fax_number": "757-336-2227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEDDY H SPENCE, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "SPENCE",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "KELLAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "757-336-5116"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401005191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2136095645751",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "0401005191",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1417977158",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Susie Melvin
• John William Moore, D.O.
• Lindsey Serena Plato-Johnson, CRNP
• Roden C Stewart, D.C.
• Margaret Elizabeth Taylor, D.C.
• Eric Andrew White, QMHP, CAC-AD, CSAC
• Jennifer Renee Wiederhold, APRN

• General Practice Dentistry in Chincoteague Island, VA
• Providers in Chincoteague Island, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.