SPENCER K. WILDE DDS NPI 1295893196

NPI Information

NPI: 1295893196
Provider Name: SPENCER K. WILDE, DDS
Classification: Dentist - 1223D0004X
Entity Type: Individual

Specialization: Dentist Anesthesiologist

Address:
625 W SOUTHERN AVE STE E-145
MESA, AZ
ZIP 85210
Phone: (480) 710-8081
Get Directions

Spencer K. Wilde, DDS is a dentist anesthesiologist dentist in Mesa, AZ. The provider is a dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology. Spencer K. Wilde, DDS NPI is 1295893196. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

625 W SOUTHERN AVE STE E-145
MESA, AZ
ZIP 85210-030
Phone: (480) 710-8081
Fax: (866) 814-1886

The enumeration date for this NPI number is 12/4/2006 and was last updated on 7/1/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223D0004X	Dentist	Dentist Anesthesiologist	25894	TEXAS	No
2	1223D0004X	Dentist	Dentist Anesthesiologist	D5497	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	884644	OTHER	ARIZONA	AHCCCS PROVIDER ID DSDA
2	863573	OTHER	ARIZONA	AHCCCS PROVIDER ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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