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NPI Code Detail

MEDICARE: DR. STEPHEN LEE GILLESPIE D.D.S.

MEDICARE: DR. STEPHEN LEE GILLESPIE D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry4902NE

General Provider Information

NPI Number : 1033207857
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN LEE GILLESPIE D.D.S.
Provider Business Mailing Address
First Line : 8613 N 30TH ST
Second Line : SUITE 103
City : OMAHA
State : NE
Zip : 68112-1852
Country : US
Telephone Number : 402-457-4350
Fax Number :
Provider Business Practice Location Address
First Line : 8613 N 30TH ST
Second Line : SUITE 103
City : OMAHA
State : NE
Zip : 68112-1852
Country : US
Telephone Number : 402-457-4350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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