MEDICARE: JULIE M GILLIS DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6642	CO

General Provider Information

NPI Number	:	1295811602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE M GILLIS DDS PC

Provider Business Mailing Address
First Line	:	1190 BOOKCLIFF AVE UNIT 201
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8159
Country	:	US
Telephone Number	:	970-242-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 BOOKCLIFF AVE UNIT 201
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8159
Country	:	US
Telephone Number	:	970-242-3635
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE M GILLIS
Credential	:	DDS
Telephone Number	:	970-242-3635

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/03/2015

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