MEDICARE: DR. WAYNE R GILLESPIE DDS

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	122300000X	Dentist	104587	CO

General Provider Information

NPI Number	:	1679785224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE R GILLESPIE DDS

Provider Business Mailing Address
First Line	:	1905 LAWRENCE ST
Second Line	:	SUITE D
City	:	DENVER
State	:	CO
Zip	:	80202-1840
Country	:	US
Telephone Number	:	303-296-4080
Fax Number	:	303-296-1444

Provider Business Practice Location Address
First Line	:	1905 LAWRENCE ST
Second Line	:	SUITE D
City	:	DENVER
State	:	CO
Zip	:	80202-1840
Country	:	US
Telephone Number	:	303-296-4080
Fax Number	:	303-296-1444

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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