MEDICARE: SPENCER S. JILEK, 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	122300000X	Dentist	60232759	WA
2	122300000X	Dentist	5582	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053678102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPENCER S. JILEK, DDS

Provider Business Mailing Address
First Line	:	9221 SANDIFUR PARKWAY
Second Line	:	SUITE B
City	:	PASCO
State	:	WA
Zip	:	99301-9241
Country	:	US
Telephone Number	:	509-547-0730
Fax Number	:	509-547-8860

Provider Business Practice Location Address
First Line	:	9221 SANDIFUR PARKWAY
Second Line	:	SUITE B
City	:	PASCO
State	:	WA
Zip	:	99301-9241
Country	:	US
Telephone Number	:	509-547-0730
Fax Number	:	509-547-8860

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CINDY M CHRISTENSEN
Credential	:
Telephone Number	:	509-547-0730

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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