Provider Demographics
NPI:1245541515
Name:GILLESPIE, MATTHEW HANS (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HANS
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 1:2467 MOSAIC WAY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8491
Mailing Address - Country:US
Mailing Address - Phone:817-793-6092
Mailing Address - Fax:
Practice Address - Street 1:2467 MOSAIC WAY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8491
Practice Address - Country:US
Practice Address - Phone:903-593-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX025547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist