Provider Demographics
NPI:1104504463
Name:DEVIN GAPSTUR, D.M.D. PA
Entity type:Organization
Organization Name:DEVIN GAPSTUR, D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAPSTUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-576-3319
Mailing Address - Street 1:8934 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3107
Mailing Address - Country:US
Mailing Address - Phone:727-576-3319
Mailing Address - Fax:
Practice Address - Street 1:8934 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3107
Practice Address - Country:US
Practice Address - Phone:727-576-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1164043402Medicaid
FL1902167760Medicaid