Provider Demographics
NPI:1356423032
Name:SPENCER, RODERICK ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:ROSS
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 STONERIDGE DR STE 3
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7047
Mailing Address - Country:US
Mailing Address - Phone:406-253-7633
Mailing Address - Fax:406-624-6833
Practice Address - Street 1:822 STONERIDGE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7047
Practice Address - Country:US
Practice Address - Phone:406-253-7633
Practice Address - Fax:406-624-6833
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist