Provider Demographics
NPI:1215478425
Name:SPENDLOVE ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:SPENDLOVE ORTHODONTICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:435-229-5340
Mailing Address - Street 1:1024 W LIL BEN TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-6993
Mailing Address - Country:US
Mailing Address - Phone:435-229-5340
Mailing Address - Fax:
Practice Address - Street 1:965 E 700 S
Practice Address - Street 2:#101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4082
Practice Address - Country:US
Practice Address - Phone:435-688-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6163992-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty