Provider Demographics
NPI:1831316694
Name:SPILLER, MICHAEL W JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:SPILLER
Suffix:JR
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 1:2200 KELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309
Mailing Address - Country:US
Mailing Address - Phone:940-322-2252
Mailing Address - Fax:940-322-7090
Practice Address - Street 1:2200 KELL BLVD.
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309
Practice Address - Country:US
Practice Address - Phone:940-322-2252
Practice Address - Fax:940-322-7090
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice