Healthcare Provider Details

I. General information

NPI: 1447373980
Provider Name (Legal Business Name): W.L. GILCREASE D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W SAN ANTONIO ST
SAN MARCOS TX
78666-5510
US

IV. Provider business mailing address

119 W SAN ANTONIO ST
SAN MARCOS TX
78666-5510
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-5549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. W. LEWIS GILCREASE
Title or Position: DENTIST
Credential: D.D.S.
Phone: 512-392-5549