Provider Demographics
NPI:1124036066
Name:GILL, CHARLES ANDRUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDRUS
Last Name:GILL
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 1:1200 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2116
Mailing Address - Country:US
Mailing Address - Phone:407-894-0084
Mailing Address - Fax:407-894-0623
Practice Address - Street 1:1200 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2116
Practice Address - Country:US
Practice Address - Phone:407-894-0084
Practice Address - Fax:407-894-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist