Individual provider Active NPI

Warren Lee Spencer, D.D.S.

  • General Practice Dentistry
  • Altamonte Springs, FL
National Provider Identifier
1356561245
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8989 Issued in FL
Practice address
994 Douglas Ave
Suite 104
Altamonte Springs, FL 32714-2068
Phone
(407) 682-5757
Fax
(407) 682-9017
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8989 FL Primary

Addresses

Primary practice location

994 Douglas Ave
Suite 104
Altamonte Springs, FL 32714-2068

Mailing address

994 Douglas Ave
Suite 104
Altamonte Springs, FL 32714-2068
Phone (407) 682-5757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20160602000671 FL Order and Referring Only - DentistPractitioner - Dentist 8123318250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8989FLMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356561245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "994 DOUGLAS AVE",
            "address_2": "SUITE 104",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142068",
            "telephone_number": "407-682-5757",
            "fax_number": "407-682-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 DOUGLAS AVE",
            "address_2": "SUITE 104",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142068",
            "telephone_number": "407-682-5757",
            "fax_number": "407-682-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "WARREN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "8989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altamonte Springs, FL

Sources for this page

Verify at the official NPI Registry.