Provider Demographics
NPI:1689700288
Name:GILSON, PHILIP ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ROBERT
Last Name:GILSON
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 1:6200 SLOCUM RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9102
Mailing Address - Country:US
Mailing Address - Phone:315-524-7433
Mailing Address - Fax:
Practice Address - Street 1:6200 SLOCUM RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9102
Practice Address - Country:US
Practice Address - Phone:315-524-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220620Medicaid