Provider Demographics
NPI:1750397592
Name:SPENCER, ANNA K (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:K
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22205 MERIDIAN AVE E STE 109
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9781
Mailing Address - Country:US
Mailing Address - Phone:253-875-6599
Mailing Address - Fax:253-875-2067
Practice Address - Street 1:9101 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE B1
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2419
Practice Address - Country:US
Practice Address - Phone:253-584-2250
Practice Address - Fax:253-584-1011
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist