Individual
SCOTT RUSSELL GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
220 W GARFIELD AVE, CHARLEVOIX, MI 49720-1631
(231) 547-6523
(231) 547-6238
Mailing address
24 CABERFAE HWY LOT 8, MANISTEE, MI 49660-1171
(248) 505-9132
(231) 398-9304
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901017529
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4798960
—
MI
Enumeration date
02/23/2007
Last updated
07/08/2007
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