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General NPI Number Information
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NPI Number | 1699737825
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Entity Type | Individual
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Provider Name | STEPHEN RICHARD GASPAROVICH DDS
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1615 TRUEMPER ST
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5511
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Country | US
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Telephone | 210-292-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 2133 KLINKER STREET, BLDG 3352 AIR FORCE POSTGRADUATE DENTAL SCHOOL
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5313
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Country | US
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Telephone | 210-292-6280
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30022122
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 33675
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License Number State | TX
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