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General NPI Number Information
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NPI Number | 1376948182
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Entity Type | Individual
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Provider Name | LATONYA F. R. GILLESPIE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 1910 HIGHWAY 20 SE STE 100
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City | CONYERS
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State | GA
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Zip | 30013-2074
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Country | US
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Telephone | 404-729-5159
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SHORELINE DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-4665
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Country | US
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Telephone | 404-729-5159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN014891
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014891
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License Number State | GA
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