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General NPI Number Information
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NPI Number | 1528323102
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Entity Type | Individual
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Provider Name | MICHAEL DAVID GILLINS DMD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 120 SOUTH ST
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City | BLUE HILL
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State | ME
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Zip | 04614-6120
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Country | US
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Telephone | 207-374-5398
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | BLUE HILL
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State | ME
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Zip | 04614-1658
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Country | US
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Telephone | 207-374-5398
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-023735
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 30.023735
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 1002001
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN4832
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License Number State | ME
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