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Spencer Gordy Dds Pa

(<Unavail>)

Dentist

Dental Providers

550 Chestnut St, Conway, AR 72032-5402

PECOS Enrollment

Based on the most recent information from CMS, provider Spencer Gordy Dds Pa does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1801203450
Provider Type
Organization
Full Name
Spencer Gordy Dds Pa
Other Name
<Unavail>

Subpart
No
Enumeration Date
7/16/2014
Last Updated
7/16/2014

Contact Information

Practice Location

550 Chestnut St, Conway, AR 72032-5402

(501) 329-8754

Unlisted Fax

Mailing Location

550 Chestnut St, Conway, AR 72032-5402

(501) 329-8754

Unlisted Fax

Authorized Official

Gordy, Spencer (President/Ceo)

(501) 733-1677

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 3926 Arkansas

Spencer Gordy Dds Pa

(<Unavail>)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Simon, Greg J

Dental Solutions Of Central Arkansas Pa

Weaver, Jennifer

Vammen, Jon C

East Oak Dental Pa

Conway Dental Center Pllc

Gordy, Spencer Preston

Pascoe, Steven B.

Hambuchen, Raymond E

Conway Regional Medical Center, Inc