Provider Demographics
NPI:1215055843
Name:GILLESPIE, JAMES H JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:GILLESPIE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 10TH AVE S STE 632
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1627
Mailing Address - Country:US
Mailing Address - Phone:205-250-6813
Mailing Address - Fax:205-250-6843
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:SUITE 632
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-250-6813
Practice Address - Fax:205-250-6843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL03782OtherBCBS PROVIDER #
AL4377OtherSTATE DENTAL LICENSE #