Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 104748 | CO |
NPI | 1043387020 |
---|---|
Provider Name | Dr. Kent J Spillman |
First Address | Arvada, CO 80003-2147 |
Second Address | Arvada, CO 80003-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |