Provider Demographics
NPI:1073194403
Name:DEVIN GAPSTUR, D.M.D. PA
Entity Type:Organization
Organization Name:DEVIN GAPSTUR, D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAPSTUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-631-5717
Mailing Address - Street 1:2052 CAROLINA AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3455
Mailing Address - Country:US
Mailing Address - Phone:772-631-5717
Mailing Address - Fax:
Practice Address - Street 1:8934 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3107
Practice Address - Country:US
Practice Address - Phone:727-576-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental