Provider Demographics
NPI:1831391978
Name:GILLILAND, ALEX C (DDS)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:C
Last Name:GILLILAND
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 1:1100 COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8824
Mailing Address - Country:US
Mailing Address - Phone:785-364-3038
Mailing Address - Fax:
Practice Address - Street 1:1100 COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8824
Practice Address - Country:US
Practice Address - Phone:785-364-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist