Provider Demographics
NPI:1871789578
Name:MICHAEL D. GILLESPIE, DDS
Entity type:Organization
Organization Name:MICHAEL D. GILLESPIE, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-456-9007
Mailing Address - Street 1:611 S HAYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3198
Mailing Address - Country:US
Mailing Address - Phone:828-456-9007
Mailing Address - Fax:828-456-9056
Practice Address - Street 1:611 S HAYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3198
Practice Address - Country:US
Practice Address - Phone:828-456-9007
Practice Address - Fax:828-456-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93191Medicaid