1053572982 NPI number — DR. LAURAN RUTH SPENCER D.D.S.

Table of content: DR. LAURAN RUTH SPENCER D.D.S. (NPI 1053572982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053572982 NPI number — DR. LAURAN RUTH SPENCER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
LAURAN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053572982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 MIDTOWN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73130-6348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-834-1312
Provider Business Mailing Address Fax Number:
405-733-8296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9060 HARMONY DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-132-1012
Provider Business Practice Location Address Fax Number:
405-733-8296
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6039 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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