Provider Demographics
NPI:1902391394
Name:GILLING, ERIK STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:STEVEN
Last Name:GILLING
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 1:725 W RAMSDELL ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:WI
Mailing Address - Zip Code:54950-8509
Mailing Address - Country:US
Mailing Address - Phone:715-754-2505
Mailing Address - Fax:
Practice Address - Street 1:725 W RAMSDELL ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:WI
Practice Address - Zip Code:54950-8509
Practice Address - Country:US
Practice Address - Phone:715-754-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100187415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1001874-15OtherDENTIST LICENSE NUMBER