Provider Demographics
NPI:1174655245
Name:TRILLI, GARY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:TRILLI
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 1:137 CRUIKSHANK ROAD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055
Mailing Address - Country:US
Mailing Address - Phone:724-353-0150
Mailing Address - Fax:
Practice Address - Street 1:137 CRUIKSHANK ROAD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055
Practice Address - Country:US
Practice Address - Phone:724-353-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022158L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice