Evelyn Spencer, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

14217 Issued in CT

Practice address

1047 Old Post Rd
Fairfield, CT 06824-5906

Phone

(203) 254-2006

NPI assigned

Jun 15, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairfield County Implants & Periodontics, PC

  • Periodontics
  • Fairfield, CT
  • NPI 1952556797
  NPD (past)
• Fairfield County Implants and Periodontics

  • Periodontics
  • Fairfield, CT
  • NPI 1518401702
  NPD (past)

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1326616319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 OLD POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245906",
            "telephone_number": "203-254-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 OLD POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245906",
            "telephone_number": "203-254-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "EVELYN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "064378",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "14217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sparkle Wellness, LLC
• Amy M Sparks, OT
• Specialty Social Services at Home, LLC
• Jessica Speed, PT, DPT
• Jonathan Alan Speicher
• Spine & Sport Fairfield LLC
• Sam A. Spinowitz, M.D.
• Julie E. Spivack, MD
• Debra L. Spross, PT, MS, OCS, CERTMDT
• Lawrence Henry Sprouse Jr., D.M.D.

• Periodontics in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.