| Russell E. Gilliom, D.d.s., P.c. | |
|
230 E Whitley St Churubusco IN 46723-1506 | |
| (260) 693-2177 | |
| (260) 693-6422 |
| Full Name | Russell E. Gilliom, D.d.s., P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 230 E Whitley St, Churubusco, Indiana |
| Authorized Official Name and Position | Russell E. Gilliom (PRESIDENT) |
| Authorized Official Contact | 2606932177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell E. Gilliom, D.d.s., P.c. Po Box 265 Churubusco IN 46723-0265 Ph: (260) 693-2177 | Russell E. Gilliom, D.d.s., P.c. 230 E Whitley St Churubusco IN 46723-1506 Ph: (260) 693-2177 |
| NPI Number | 1902021827 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902021827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 54000935A (Indiana) | Primary |
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