Individual
DR. JOHN MALCOLM GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1441 N 12TH ST FL 23, PHOENIX, AZ 85006-2837
(602) 521-5150
(602) 521-5151
Mailing address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 521-5150
(602) 521-5151
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6147
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
931982
—
AZ
Enumeration date
03/22/2006
Last updated
01/17/2022
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