Provider Demographics
NPI:1093925851
Name:GILLIGAN, JAMES J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:GILLIGAN
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 1:51 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1619
Mailing Address - Country:US
Mailing Address - Phone:860-423-5735
Mailing Address - Fax:860-423-3324
Practice Address - Street 1:236 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1443
Practice Address - Country:US
Practice Address - Phone:860-423-0045
Practice Address - Fax:860-423-3324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist