Jonathan Wade Gillesby – General Practice Dentistry

Key facts

NPI: 1467567057
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 2901017899 (MI)
Practice address: 530 Riverside Drive
Dowagiac, MI 49047
Phone: (269) 782-5161
Fax: (269) 782-1126
NPI assigned: Aug 21, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Dowagiac Family Dentistry, PC Dental Clinic/Center · Dowagiac, MI · NPI 1811414931

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
2901017899	MI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Dowagiac Family Dentistry, PC		Current since Jul 24, 2022	Accepting new patients

Locations

530 Riverside Dr
Dowagiac, MI 49047
Phone (269) 782-5161

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	2901017899	MI	Yes

Addresses

Primary practice location

530 Riverside Drive
Dowagiac, MI 49047

Mailing address

530 Riverside Drive
Dowagiac, MI 49047
Phone (269) 782-5161

Other providers in Dowagiac, MI

All providers in Dowagiac, MI · General Practice Dentistry in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.