Glenn Dela Llana Gequillana, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

5003015 Issued in WI

Practice address

2901 W Kinnickinnic River Pkwy
Suite 104
Milwaukee, WI 53215-3677

Phone

(414) 649-3510

Fax

(414) 385-2854

NPI assigned

Dec 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 21, 2012 through Sep 21, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Parkway Dental, S.C.

  • General Practice Dentistry
  • Milwaukee, WI
  • NPI 1578856225
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154484616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 104",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153677",
            "telephone_number": "414-649-3510",
            "fax_number": "414-385-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W KINNICKINNIC RIVER PKWY",
            "address_2": "SUITE 104",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153677",
            "telephone_number": "414-649-3510",
            "fax_number": "414-385-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEQUILLANA",
        "first_name": "GLENN",
        "middle_name": "DELA LLANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5003015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan D George
• Samuel Joseph George, DO
• William Aristides George IV, ATC/LAT
• Christina Georgeades, MD
• Alexander Ray Georgeson, CRNA, BSN
• Gail Lavoie Geraci, DNP
• Teresa Geraghty, MSW LCSW
• Gerald L Ignace Indian Dental Center, LLC
• Gerald L. Ignace Indian Health Center, Inc.
• Gerald L. Ignace Indian Health Center, Inc.

• All providers in Milwaukee, WI
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.