Provider Demographics
NPI:1558528927
Name:SPILLANE, KEVIN G (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:SPILLANE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 W BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3209
Mailing Address - Country:US
Mailing Address - Phone:215-822-2005
Mailing Address - Fax:215-997-8510
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
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics