MEDICARE: DR. JAMES ANTHONY SPINELLI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	08782	NJ

General Provider Information

NPI Number	:	1639171721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ANTHONY SPINELLI DDS

Provider Business Mailing Address
First Line	:	30 MILLSTREAM DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-4504
Country	:	US
Telephone Number	:	856-778-4365
Fax Number	:	856-663-0441

Provider Business Practice Location Address
First Line	:	5924 WESTFIELD AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1842
Country	:	US
Telephone Number	:	856-663-4881
Fax Number	:	856-663-0441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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