MEDICARE: WAYNE R. GILLESPIE, DDS, PC

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	104587	CO

General Provider Information

NPI Number	:	1740382209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE R. GILLESPIE, DDS, PC

Provider Business Mailing Address
First Line	:	1905 LAWRENCE ST UNIT D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1826
Country	:	US
Telephone Number	:	303-296-4080
Fax Number	:	303-296-1444

Provider Business Practice Location Address
First Line	:	1905 LAWRENCE ST UNIT D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1826
Country	:	US
Telephone Number	:	303-296-4080
Fax Number	:	303-296-1444

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WAYNE R GILLESPIE
Credential	:	DDS
Telephone Number	:	303-296-4080

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	08/22/2020

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