Healthcare Provider Details

I. General information

NPI: 1033258595
Provider Name (Legal Business Name): KEVIN G SPILLANE DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W BUTLER AVE
CHALFONT PA
18914-3209
US

IV. Provider business mailing address

113 HICKORY HOLLOW CIR
WARRINGTON PA
18976-2564
US

V. Phone/Fax

Practice location:
  • Phone: 215-822-2005
  • Fax: 215-997-8510
Mailing address:
  • Phone: 215-918-0883
  • Fax: 215-918-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS035954
License Number StatePA

VIII. Authorized Official

Name: DR. KEVIN G SPILLANE
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 215-918-0883