Provider Demographics
NPI:1588000186
Name:SPILLERS, CHAD STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:STEPHEN
Last Name:SPILLERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 S PURPERA AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4361
Mailing Address - Country:US
Mailing Address - Phone:225-647-3577
Mailing Address - Fax:225-647-8762
Practice Address - Street 1:1116 S PURPERA AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4361
Practice Address - Country:US
Practice Address - Phone:225-647-3577
Practice Address - Fax:225-647-8762
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice