Provider Demographics
NPI:1548243157
Name:GILLIS, RICHARD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:GILLIS
Suffix:
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 1:1211 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2603
Mailing Address - Country:US
Mailing Address - Phone:781-444-4782
Mailing Address - Fax:781-455-1416
Practice Address - Street 1:1211 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2603
Practice Address - Country:US
Practice Address - Phone:781-444-4782
Practice Address - Fax:781-455-1416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice