MEDICARE: ALLISON MCLEOD SPILLERS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	7728	LA

General Provider Information

NPI Number	:	1700638053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MCLEOD SPILLERS

Provider Business Mailing Address
First Line	:	530 S WAKARA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3422 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7310
Country	:	US
Telephone Number	:	318-497-4007
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	08/04/2025

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