=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649663014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERYONE DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3464 N. SALIDA ST UNIT B
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80011-5020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-307-9999
-----------------------------------------------------
Fax | 303-307-9992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3471 N SALIDA CT AUIE 40
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80011-5020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-307-9999
-----------------------------------------------------
Fax | 303-307-9992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENIST/ OWNER
-----------------------------------------------------
Name | DR. ANDRE GILLESPIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-307-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------