Provider Demographics
NPI:1760596290
Name:GILLAN, TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:GILLAN
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 1:2186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8637
Mailing Address - Country:US
Mailing Address - Phone:616-897-8491
Mailing Address - Fax:616-897-8350
Practice Address - Street 1:2186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8637
Practice Address - Country:US
Practice Address - Phone:616-897-8491
Practice Address - Fax:616-897-8350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010127911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice