Provider Demographics
NPI:1457647711
Name:GILLAN, JERE SCOTT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERE
Middle Name:SCOTT
Last Name:GILLAN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9388 RAVENS WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7080
Mailing Address - Country:US
Mailing Address - Phone:407-929-0511
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-453-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN194181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice