=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639171721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES ANTHONY SPINELLI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5924 WESTFIELD AVE
-----------------------------------------------------
City | PENNSAUKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08110-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-663-4881
-----------------------------------------------------
Fax | 856-663-0441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 MILLSTREAM DR
-----------------------------------------------------
City | MOUNT LAUREL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08054-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-778-4365
-----------------------------------------------------
Fax | 856-663-0441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 08782
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------