Provider Demographics
NPI:1801091038
Name:GILLIS, JULIE M (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:GILLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-3635
Mailing Address - Fax:
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:STE 201
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice