Provider Demographics
NPI:1730248774
Name:GILLING, CHRISTOPHER P (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:GILLING
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 1:725 W RAMSDELL STREET
Mailing Address - Street 2:PO BOX 482
Mailing Address - City:MARION
Mailing Address - State:WI
Mailing Address - Zip Code:54950-0482
Mailing Address - Country:US
Mailing Address - Phone:715-754-2505
Mailing Address - Fax:715-754-4473
Practice Address - Street 1:725 W RAMSDELL STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:WI
Practice Address - Zip Code:54950-0482
Practice Address - Country:US
Practice Address - Phone:715-754-2505
Practice Address - Fax:715-754-4473
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33415100Medicaid
WI77748Medicare ID - Type Unspecified