Provider Demographics
NPI:1619087798
Name:GISSEL, PHILIP CHARLET (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CHARLET
Last Name:GISSEL
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 1:31450 WILDWOOD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9010
Mailing Address - Country:US
Mailing Address - Phone:541-684-9751
Mailing Address - Fax:541-484-6398
Practice Address - Street 1:366 E 40TH AVE
Practice Address - Street 2:STE 210
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3494
Practice Address - Country:US
Practice Address - Phone:541-484-6974
Practice Address - Fax:541-484-6398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR66461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice