Provider Demographics
NPI:1457356883
Name:GILLMAN, CYRIL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:G
Last Name:GILLMAN
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 1:12027 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2428
Mailing Address - Country:US
Mailing Address - Phone:718-723-1552
Mailing Address - Fax:718-723-7265
Practice Address - Street 1:12027 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2428
Practice Address - Country:US
Practice Address - Phone:718-723-1552
Practice Address - Fax:718-723-7265
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice