Evangelyn Aletheia Spencer, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D0006178 Issued in AL

Practice address

1115 Azalea PL
Brewton, AL 36426-1318

Phone

(251) 867-8020

Fax

(251) 867-8079

NPI assigned

May 7, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1760892160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 DR MARTIN L KING JR AVE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366035341",
            "telephone_number": "251-432-4117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 AZALEA PL",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261318",
            "telephone_number": "251-867-8020",
            "fax_number": "251-867-8079"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Westchester Hl Rm 151",
            "address_2": "Hosptial Dentistry",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117948711",
            "country_code": "US",
            "telephone_number": "631-444-2557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "EVANGELYN",
        "middle_name": "ALETHEIA",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-07",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "D0006178",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "D0006178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173506",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Brewton, AL
• Providers in Brewton, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; 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.