1639378318 NPI number — DAVID W. GILLETT D.M.D., INC.

Table of content: (NPI 1639378318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639378318 NPI number — DAVID W. GILLETT D.M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID W. GILLETT D.M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1639378318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7080 SKYWAY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARADISE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95969-3928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-877-6586
Provider Business Mailing Address Fax Number:
530-872-0929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7080 SKYWAY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-877-6586
Provider Business Practice Location Address Fax Number:
530-872-0929
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLETT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-877-6586

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22353 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22353 . This is a "STATE OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com