Provider Demographics
NPI:1093498974
Name:GILLIN, RUPERT NEIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:NEIKO
Last Name:GILLIN
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 1:1286 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3242
Mailing Address - Country:US
Mailing Address - Phone:301-761-4489
Mailing Address - Fax:
Practice Address - Street 1:1286 E WEST HWY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3242
Practice Address - Country:US
Practice Address - Phone:301-761-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist