Provider Demographics
NPI:1508990920
Name:GILMAN, TERRENCE ROBERT SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ROBERT
Last Name:GILMAN
Suffix:SR
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 1:13015 S MCVICKERS AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2354
Mailing Address - Country:US
Mailing Address - Phone:708-371-7712
Mailing Address - Fax:
Practice Address - Street 1:8233 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1691
Practice Address - Country:US
Practice Address - Phone:708-430-5088
Practice Address - Fax:708-430-5090
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA145651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice