Provider Demographics
NPI:1740382209
Name:WAYNE R. GILLESPIE, DDS, PC
Entity Type:Organization
Organization Name:WAYNE R. GILLESPIE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-296-4080
Mailing Address - Street 1:1905 LAWRENCE ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1826
Mailing Address - Country:US
Mailing Address - Phone:303-296-4080
Mailing Address - Fax:303-296-1444
Practice Address - Street 1:1905 LAWRENCE ST UNIT D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1826
Practice Address - Country:US
Practice Address - Phone:303-296-4080
Practice Address - Fax:303-296-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1045871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty