1750343638 NPI number — STEVEN GILLEN DMD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750343638 NPI number — STEVEN GILLEN DMD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GILLEN

Provider First Name:

STEVEN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DMD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1750343638

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

926 GREAT POND DR

Provider Second Line Business Mailing Address:

SUITE 2003

Provider Business Mailing Address City Name:

ALTAMONTE SPRINGS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

32714-7244

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

407-772-5124

Provider Business Mailing Address Fax Number:

407-788-3572

Provider First Line Business Practice Location Address:

ROUTE 19

Provider Second Line Business Practice Location Address:

NORTHGATE PLAZA

Provider Business Practice Location Address City Name:

WASHINGTON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15301

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-223-0750

Provider Business Practice Location Address Fax Number:

724-223-8761

Provider Enumeration Date:

04/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 122300000X , with the licence number:  DS028891 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0014570640004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0014570640018 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".