Provider Demographics
NPI:1336289149
Name:ROBINSON WARNER, GILLIAN ALLISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:ALLISON
Last Name:ROBINSON WARNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 GALLANT FOX LN
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4003
Mailing Address - Country:US
Mailing Address - Phone:301-805-6589
Mailing Address - Fax:301-805-6109
Practice Address - Street 1:14300 GALLANT FOX LN
Practice Address - Street 2:SUITE 111
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4003
Practice Address - Country:US
Practice Address - Phone:301-805-6589
Practice Address - Fax:301-805-6109
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224421223G0001X
MD142331223G0001X
VA04014118041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260135218034OtherCARE SOURCE PROVIDER #
OH9185208OtherDORAL PROVIDER #
OH2674280Medicaid