Provider Demographics
NPI:1548273584
Name:GILLIG, JEFFREY ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:GILLIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 N STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6058
Mailing Address - Country:US
Mailing Address - Phone:614-890-2522
Mailing Address - Fax:614-882-2931
Practice Address - Street 1:574 N STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6058
Practice Address - Country:US
Practice Address - Phone:614-890-2522
Practice Address - Fax:614-882-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice