Individual
JOHN PHILIP GILLESPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4426 TERRY RD, JACKSON, MS 39212-5616
(601) 372-8363
Mailing address
4426 TERRY ROAD, JACKSON, MS 39212-5616
(601) 372-8363
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2823-94
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660119
—
MS
Enumeration date
05/09/2007
Last updated
07/09/2007
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