Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D009339 | AZ |
NPI | 1003285834 |
---|---|
Provider Name | Spencer Torgerson |
First Address | Queen Creek, AZ 85142-6127 |
Second Address | Queen Creek, AZ 85142-6127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 23/09/2015 |