Individual
DR. RUSSELL ERIC GILLIOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
230 E WHITLEY ST, CHURUBUSCO, IN 46723-1506
(260) 693-2177
(260) 693-6422
Mailing address
PO BOX 265, CHURUBUSCO, IN 46723-0265
(260) 693-2177
(260) 693-6422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007296
IN
Other
Enumeration date
04/16/2007
Last updated
01/14/2008
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