Provider Demographics
NPI:1659302958
Name:SPILLER, JOEL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:SPILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2046
Mailing Address - Country:US
Mailing Address - Phone:978-851-7890
Mailing Address - Fax:978-851-7734
Practice Address - Street 1:1418 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2046
Practice Address - Country:US
Practice Address - Phone:978-851-7890
Practice Address - Fax:978-851-7734
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice