Provider Demographics
NPI:1538723986
Name:SPINELLA, MARY KATHERINE (MD, DMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:SPINELLA
Suffix:
Gender:F
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOUSTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2451
Mailing Address - Country:US
Mailing Address - Phone:405-569-3492
Mailing Address - Fax:
Practice Address - Street 1:112 HOUSTON ST STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2451
Practice Address - Country:US
Practice Address - Phone:540-569-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014193801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery