Provider Demographics
NPI:1740203454
Name:GILLESPIE, TIMOTHY EDWARD
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3015
Mailing Address - Country:US
Mailing Address - Phone:828-277-1411
Mailing Address - Fax:
Practice Address - Street 1:36 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2341
Practice Address - Country:US
Practice Address - Phone:828-252-9351
Practice Address - Fax:828-251-9085
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93192Medicaid