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General NPI Number Information
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NPI Number | 1215255518
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Entity Type | Organization
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Legal Business Name | STEPHEN B GILLESPIE DDS LLC
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 13200 SE MCGILLIVRAY BLVD
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City | VANCOUVER
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State | WA
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Zip | 98683-7040
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Country | US
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Telephone | 360-892-6132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25528
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City | TEMPE
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State | AZ
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Zip | 85285-5528
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Country | US
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Telephone | 480-444-0607
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Fax | 480-777-1345
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | STEPHEN GILLESPIE
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Credential |
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Telephone | 360-892-6132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE 00005353
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License Number State | WA
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