# RUSSELL E. GILLIOM, D.D.S., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902021827
- **Authorized official:** DR. RUSSELL E. GILLIOM D.D.S. (PRESIDENT)
- **Authorized official phone:** (260) 693-2177

## Contact information

- **Practice address:** 230 E WHITLEY ST, CHURUBUSCO, IN 46723-1506
- **Practice address phone:** (260) 693-2177
- **Practice address fax:** (260) 693-6422
- **Mailing address:** PO BOX 265, CHURUBUSCO, IN 46723-0265
- **Mailing address phone:** (260) 693-2177
- **Mailing address fax:** (260) 693-6422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 54000935A | IN | Yes |

## Other

- **Enumeration date:** 04/16/2007
- **Last updated:** 08/22/2020