MEDICARE: DR. KENT J SPILLMAN 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	1223P0300X	Periodontics	104748	CO

General Provider Information

NPI Number	:	1043387020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT J SPILLMAN DDS

Provider Business Mailing Address
First Line	:	7502 WEST 80TH AVE
Second Line	:	SUITE 100
City	:	ARVADA
State	:	CO
Zip	:	80003-2147
Country	:	US
Telephone Number	:	303-424-7757
Fax Number	:	303-403-0268

Provider Business Practice Location Address
First Line	:	7502 WEST 80TH AVE
Second Line	:	SUITE 100
City	:	ARVADA
State	:	CO
Zip	:	80003-2147
Country	:	US
Telephone Number	:	303-424-7757
Fax Number	:	303-403-0268

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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