MEDICARE: DR. JOSEPH C.D. GILLESPIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3915	SC

General Provider Information

NPI Number	:	1144498213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH C.D. GILLESPIE

Provider Business Mailing Address
First Line	:	1051 JOHNNIE DODDS BLVD
Second Line	:	SUITE A
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3100
Country	:	US
Telephone Number	:	843-388-9690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 JOHNNIE DODDS BLVD
Second Line	:	SUITE A
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3100
Country	:	US
Telephone Number	:	843-388-9690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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