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3000 L St Ste 205 Sacramento CA 95816-5248 | |
| (916) 731-5778 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Prosthodontics |
| Location | 3000 L St Ste 205, Sacramento, California |
| Authorized Official Name and Position | Robert E Gillis (DOCTOR) |
| Authorized Official Contact | 9167315778 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3000 L St Ste 205 Sacramento CA 95816-5248 Ph: (916) 731-5778 | 3000 L St Ste 205 Sacramento CA 95816-5248 Ph: (916) 731-5778 |
| NPI Number | 1710176086 |
|---|---|
| Provider Enumeration Date | 10/23/2007 |
| Last Update Date | 10/23/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710176086 | NPI | - | NPPES |
| B2207001 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 22070 (California) | Primary |
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