Active NPI
Brian Spencer, DMD
- Dentist
- Chinle, AZ
National Provider Identifier
1811530819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D010439
- Practice address
- U.S. 191 and Hospital Drive
Chinle, AZ 86503 - Phone
- (928) 674-7001
- NPI assigned
- Oct 22, 2019
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D010439 | AZ | Primary |
Addresses
Primary practice location
U.S. 191 and Hospital Drive
Chinle, AZ 86503
Mailing address
PO Box 310
Chinle, AZ 86503-0310
Phone (480) 440-2252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191217002585 | TX | Order and Referring Only - Oral Surgery | 6608200092 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D010439 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1811530819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 310",
"city": "CHINLE",
"state": "AZ",
"postal_code": "865030310",
"telephone_number": "480-440-2252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "U.S. 191 AND HOSPITAL DRIVE",
"city": "CHINLE",
"state": "AZ",
"postal_code": "86503",
"telephone_number": "928-674-7001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D010439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chinle, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.