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NPI Code Detail

MEDICARE: DR. JERE SCOTT GILLAN JR. DMD

MEDICARE: DR. JERE SCOTT GILLAN JR. DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN19418FL

General Provider Information

NPI Number : 1457647711
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERE SCOTT GILLAN JR. DMD
Provider Business Mailing Address
First Line : 9388 RAVENS WILLOW DR
Second Line :
City : ORLANDO
State : FL
Zip : 32827-7080
Country : US
Telephone Number : 407-929-0511
Fax Number :
Provider Business Practice Location Address
First Line : 800 E MERRITT CSWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-3514
Country : US
Telephone Number : 321-453-8882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 06/24/2011

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