Krystal Gillis

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2008016892 Issued in MO

Practice address

1108 E Ohio St
Clinton, MO 64735-2458

Phone

(660) 885-6933

NPI assigned

Jan 17, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Gillis Family Dentistry

  • General Practice Dentistry
  • Clinton, MO
  • NPI 1972992162
  NPD Authorized official
• Gillis Family Dentistry LLC

  • General Practice Dentistry
  • Warrensburg, MO
  • NPI 1629842216
  NPD Authorized official

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

{
    "created_epoch": "1263686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1477884351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 E OHIO ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647352458",
            "telephone_number": "660-885-6933",
            "fax_number": "660-885-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 E OHIO ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647352458",
            "telephone_number": "660-885-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "KRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-17",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08688",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2008016892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Gamber, DPT
• Sunanda Ghosh, MD
• Joseph S Gialde, D.O.
• Michael Andrew Gilbert, DO
• Gillis Family Dentistry
• Debra L Goffinet, M. A. CCC-A
• Joseph Mark Goffinet, M.S., CCC-A
• Golden Valley Emergency Physicians, LLC
• Golden Valley Memorial Hospital
• Golden Valley Memorial Hospital

• General Practice Dentistry in Clinton, MO
• Providers in Clinton, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.