Provider Demographics
NPI:1568020022
Name:LOSEKE, GILLIAN JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:JEAN
Last Name:LOSEKE
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 1:805 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5282
Mailing Address - Country:US
Mailing Address - Phone:308-534-1289
Mailing Address - Fax:
Practice Address - Street 1:805 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5282
Practice Address - Country:US
Practice Address - Phone:308-534-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice