Healthcare Provider Details

I. General information

NPI: 1790604585
Provider Name (Legal Business Name): CALLUM ELIAS GILL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 CONSTITUTION AVE STE 110
COLORADO SPRINGS CO
80951-8903
US

IV. Provider business mailing address

7935 CONSTITUTION AVE STE 110
COLORADO SPRINGS CO
80951-8903
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-9668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206770
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: