Provider Demographics
NPI:1801516265
Name:SCHLOTH GILLIGAN, BROOKE (DMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:SCHLOTH GILLIGAN
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 1:12086 FORT CAROLINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2688
Mailing Address - Country:US
Mailing Address - Phone:904-807-9127
Mailing Address - Fax:
Practice Address - Street 1:12086 FORT CAROLINE RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2688
Practice Address - Country:US
Practice Address - Phone:904-807-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN273881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice