Provider Demographics
NPI:1023205952
Name:GILLETTE, WILLIAM ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:GILLETTE
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:W16535 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:GOULD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W16535 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:GOULD CITY
Practice Address - State:MI
Practice Address - Zip Code:49838
Practice Address - Country:US
Practice Address - Phone:906-477-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist