Provider Demographics
NPI:1780571422
Name:GILLELAND, BRANDI (RDH)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:GILLELAND
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:CO
Mailing Address - Zip Code:81151-0316
Mailing Address - Country:US
Mailing Address - Phone:719-480-3285
Mailing Address - Fax:
Practice Address - Street 1:240 HICKORY ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:CO
Practice Address - Zip Code:81151
Practice Address - Country:US
Practice Address - Phone:719-480-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000905856124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist