Provider Demographics
NPI:1962510545
Name:COLMENAR, GIL ILANO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:ILANO
Last Name:COLMENAR
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SAVIERS RD STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6429
Mailing Address - Country:US
Mailing Address - Phone:805-483-6652
Mailing Address - Fax:805-385-7382
Practice Address - Street 1:3711 SAVIERS RD
Practice Address - Street 2:SUITE A
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6475
Practice Address - Country:US
Practice Address - Phone:805-483-6652
Practice Address - Fax:805-385-7382
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431311223G0001X, 1223X2210X, 125Q00000X, 174400000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223X2210XDental ProvidersDentistOrofacial Pain
No125Q00000XDental ProvidersOral Medicinist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA863288OtherUNITED CONCORDIA ID NO.
CAB4341-01OtherDENTI-CAL