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General NPI Number Information
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NPI Number | 1376275917
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Entity Type | Organization
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Legal Business Name | GILLARD DENTAL SERVICES PLLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 13575 W INDIAN SCHOOL RD STE 600
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4925
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Country | US
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Telephone | 909-965-2254
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Fax |
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Provider Business Mailing Address
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Address Line | 31040 E SUNSET DR N
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City | REDLANDS
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State | CA
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Zip | 92373-7453
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | TRENT HUNTER GILLARD
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Credential | DDS
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Telephone | 909-965-2254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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