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Contact Information

SPENCER K WILDE, DDS
625 W SOUTHERN AVE STE E-145
MESA, AZ85210-5030
 Phone: 480-710-8081
 Fax: 866-814-1886
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist Anesthesiologist

1223D0004X
Indicates primary specialty

NPI Profile & details for SPENCER K WILDE · (Male)

NPI Number 1295893196
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 12/04/2006
Last updated 07/01/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # D5497
  • TX License # 25894
  • AZ Other 863573 AHCCCS PROVIDER ID
  • AZ Other 884644 AHCCCS PROVIDER ID DSDA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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