Provider Demographics
NPI:1033258595
Name:KEVIN G SPILLANE DDS MS PC
Entity Type:Organization
Organization Name:KEVIN G SPILLANE DDS MS PC
Other - Org Name:SPILLANE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPILLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:215-918-0883
Mailing Address - Street 1:113 HICKORY HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2564
Mailing Address - Country:US
Mailing Address - Phone:215-918-0883
Mailing Address - Fax:215-918-0883
Practice Address - Street 1:530 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3209
Practice Address - Country:US
Practice Address - Phone:215-822-2005
Practice Address - Fax:215-997-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty