Drew Gilley
Individual provider Active NPI Dentist · Roosevelt, UT
NPI 1780036772 · NPPES record last updated Jul 1, 2016
Key facts
- NPI
- 1780036772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 9816603-9922 (UT)
- Practice address
- 375 E Lagoon St,
Roosevelt, Ut 84066
Roosevelt, UT 84066 - Phone
- (435) 722-9995
- NPI assigned
- Jul 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 9816603-9922 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountainlands Community Health Center, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/11721/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9816603-9922 | UT | Yes |
Addresses
Primary practice location
375 E Lagoon St,
Roosevelt, Ut 84066
Roosevelt, UT 84066
Mailing address
483 N 190 E
Roosevelt, UT 84066-2573
Phone (801) 707-7825
Other providers in Roosevelt, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2016. 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.