Provider Demographics
NPI:1972785533
Name:GILLIHAN, AMY LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEIGH
Last Name:GILLIHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 S 291 HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2602
Mailing Address - Country:US
Mailing Address - Phone:816-373-5400
Mailing Address - Fax:
Practice Address - Street 1:3151 S 291 HWY
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2602
Practice Address - Country:US
Practice Address - Phone:816-373-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030106171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics