Provider Demographics
NPI:1659497436
Name:SPINELLI DENTAL PLLC
Entity type:Organization
Organization Name:SPINELLI DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-458-5700
Mailing Address - Street 1:2070 LYELL AVE
Mailing Address - Street 2:STE.200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5715
Mailing Address - Country:US
Mailing Address - Phone:585-458-5700
Mailing Address - Fax:
Practice Address - Street 1:2070 LYELL AVE
Practice Address - Street 2:STE.200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5715
Practice Address - Country:US
Practice Address - Phone:585-458-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty