Provider Demographics
NPI:1821180217
Name:GILLESPIE, JANICE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYNN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1922
Mailing Address - Country:US
Mailing Address - Phone:631-584-8924
Mailing Address - Fax:631-584-8937
Practice Address - Street 1:559 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1922
Practice Address - Country:US
Practice Address - Phone:631-584-8924
Practice Address - Fax:631-584-8937
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0294991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice