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General NPI Number Information
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NPI Number | 1558417469
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Entity Type | Organization
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Legal Business Name | DR DENNIS M GILLESPIE
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1317 N ELM
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-682-8518
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Fax | 641-683-7599
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Provider Business Mailing Address
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Address Line | 1317 N ELM
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-682-8518
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Fax | 641-683-7599
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DENNIS MATTHEW GILLESPIE
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Credential | DDD
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Telephone | 641-682-8518
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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 | 6290
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License Number State | IA
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