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General NPI Number Information
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NPI Number | 1033603030
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Entity Type | Individual
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Provider Name | MARCUS RYAN GILLON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 7500 CAMBRIDGE STREET SUITE 6510
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City | HOUSTON
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State | TX
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Zip | 77054
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Country | US
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Telephone | 713-486-4052
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Fax | 713-486-4333
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Provider Business Mailing Address
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Address Line | 7500 CAMBRIDGE ST STE 6510
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City | HOUSTON
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State | TX
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Zip | 77054-6010
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Country | US
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Telephone | 713-486-4052
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Fax | 713-486-4333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 018.002071
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License Number State | NC
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