Provider Demographics
NPI:1518168590
Name:GILLESPIE, CARTER E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:E
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 67 DIETZ SHOPPING CTR.
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45715
Mailing Address - Country:US
Mailing Address - Phone:740-984-2368
Mailing Address - Fax:
Practice Address - Street 1:521 FIFTH ST.
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:OH
Practice Address - Zip Code:45715
Practice Address - Country:US
Practice Address - Phone:740-984-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 154341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH 15434OtherSTATE LICENSE