Organization
RUSSELL E. GILLIOM, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL E. GILLIOM D.D.S. (PRESIDENT)
(260) 693-2177
Entity
Organization
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
261QD0000X
Dental Clinic/Center
Primary
54000935A
IN
Other
Enumeration date
04/16/2007
Last updated
08/22/2020
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