Provider Demographics
NPI:1528079738
Name:SPILSBURY, DARRELL KEITH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:KEITH
Last Name:SPILSBURY
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:731 MALL RING CIR
Mailing Address - Street 2:#100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6683
Mailing Address - Country:US
Mailing Address - Phone:702-434-0063
Mailing Address - Fax:702-434-0813
Practice Address - Street 1:731 MALL RING CIR
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6683
Practice Address - Country:US
Practice Address - Phone:702-434-0063
Practice Address - Fax:702-434-0813
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-36 23731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics