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General NPI Number Information
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NPI Number | 1710176086
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Entity Type | Organization
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Legal Business Name | ROBERT E. GILLIS, JR, DMD, MSD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 3000 L ST STE 205
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City | SACRAMENTO
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State | CA
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Zip | 95816-5248
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Country | US
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Telephone | 916-731-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 L ST STE 205
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City | SACRAMENTO
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State | CA
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Zip | 95816-5248
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Country | US
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Telephone | 916-731-5778
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT E GILLIS
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Credential |
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Telephone | 916-731-5778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22070
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License Number State | CA
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