Provider Demographics
NPI:1679633184
Name:GILLESPIE, STEPHEN B (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:B
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 1:13200 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7040
Mailing Address - Country:US
Mailing Address - Phone:360-892-6132
Mailing Address - Fax:360-892-0297
Practice Address - Street 1:13200 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7040
Practice Address - Country:US
Practice Address - Phone:360-892-6132
Practice Address - Fax:360-892-0297
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5557301OtherDSHS
WA6401060001Medicare NSC