Provider Demographics
NPI:1710325675
Name:GILLESPIE, DENNIS HERBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:HERBERT
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 1:109 S. 65TH AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642
Mailing Address - Country:US
Mailing Address - Phone:360-887-2333
Mailing Address - Fax:360-887-0607
Practice Address - Street 1:109 S. 65TH AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642
Practice Address - Country:US
Practice Address - Phone:360-887-2333
Practice Address - Fax:360-887-0607
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60369656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist