Provider Demographics
NPI:1033603030
Name:GILLON, MARCUS RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:RYAN
Last Name:GILLON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:7500 CAMBRIDGE ST STE 6510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-6010
Mailing Address - Country:US
Mailing Address - Phone:713-486-4052
Mailing Address - Fax:713-486-4333
Practice Address - Street 1:7500 CAMBRIDGE STREET
Practice Address - Street 2:SUITE 6510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4052
Practice Address - Fax:713-486-4333
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2019-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC018.002071204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery