Active NPI
Kenneth R Spence, DDS
- General Practice Dentistry
- College Station, TX
National Provider Identifier
1578765582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14892
- Practice address
- 2700 Earl Rudder Fwy S
Suite 1900
College Station, TX 77845-5010 - Phone
- (979) 696-4511
- NPI assigned
- Jun 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14892 | TX | Primary |
Addresses
Primary practice location
2700 Earl Rudder Fwy S
Suite 1900
College Station, TX 77845-5010
Mailing address
2700 Earl Rudder Fwy S
Suite 1900
College Station, TX 77845-5010
Phone (979) 696-4511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82D691 | Other | TX | BCBS PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14892 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aggieland Dental Associates, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- College Station, TX
- NPI 1407078892
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578765582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 EARL RUDDER FWY S",
"address_2": "SUITE 1900",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778455010",
"telephone_number": "979-696-4511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 EARL RUDDER FWY S",
"address_2": "SUITE 1900",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778455010",
"telephone_number": "979-696-4511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCE",
"first_name": "KENNETH",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14892",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "82D691",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.