Kyle Spackman, DDS
Individual provider Active NPI Dentist · Richmond, UT
NPI 1639730617 · NPPES record last updated Jun 21, 2019
Key facts
- NPI
- 1639730617
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11299320-9922 (UT)
- Practice address
- 105 S 200 W
Richmond, UT 84333-1278 - Phone
- (435) 258-2301
- NPI assigned
- Jun 21, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11299320-9922 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherry Creek Dental | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11299320-9922 | UT | Yes |
Addresses
Primary practice location
105 S 200 W
Richmond, UT 84333-1278
Mailing address
98 W 100 S
Smithfield, UT 84335-1956
Phone (435) 668-6479
Other providers in Richmond, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.