Provider Demographics
NPI:1699737825
Name:GASPAROVICH, STEPHEN RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RICHARD
Last Name:GASPAROVICH
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 1:606 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2513
Mailing Address - Country:US
Mailing Address - Phone:228-376-3021
Mailing Address - Fax:
Practice Address - Street 1:606 FISHER ST
Practice Address - Street 2:
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534-2513
Practice Address - Country:US
Practice Address - Phone:282-376-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300221221223P0221X
TX336751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry