Provider Demographics
NPI:1053678102
Name:SPENCER S. JILEK, DDS
Entity Type:Organization
Organization Name:SPENCER S. JILEK, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-547-0730
Mailing Address - Street 1:9221 SANDIFUR PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9241
Mailing Address - Country:US
Mailing Address - Phone:509-547-0730
Mailing Address - Fax:509-547-8860
Practice Address - Street 1:9221 SANDIFUR PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9241
Practice Address - Country:US
Practice Address - Phone:509-547-0730
Practice Address - Fax:509-547-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5582122300000X
WA60232759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5475502Medicaid