Provider Demographics
NPI:1871285023
Name:CARLILE, SPENCER (DMD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:CARLILE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9750 COVINGTON CROSS DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-7042
Practice Address - Country:US
Practice Address - Phone:702-341-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-06-14
Deactivation Date:2024-06-04
Deactivation Code:
Reactivation Date:2024-06-14
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV80021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program