Provider Demographics
NPI:1386867687
Name:GILLIS, ERROL MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:MICHAEL
Last Name:GILLIS
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 1:1901 OLYMPIC BLVD
Mailing Address - Street 2:#105
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5076
Mailing Address - Country:US
Mailing Address - Phone:925-943-2675
Mailing Address - Fax:
Practice Address - Street 1:1901 OLYMPIC BLVD
Practice Address - Street 2:#105
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5076
Practice Address - Country:US
Practice Address - Phone:925-943-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics