Provider Demographics
NPI:1528346301
Name:SPILLERS, JEFFREY RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RYAN
Last Name:SPILLERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S PARK AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1697
Mailing Address - Country:US
Mailing Address - Phone:775-830-3409
Mailing Address - Fax:775-825-7575
Practice Address - Street 1:4600 S PARK AVE STE 6
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1697
Practice Address - Country:US
Practice Address - Phone:775-830-3409
Practice Address - Fax:775-825-7575
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist