NPIMap

Organization Active NPI

Gillis Family Dentistry

  • General Practice Dentistry
  • Clinton, MO
National Provider Identifier
1972992162
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2008016892 Issued in MO
Legal business name
GILLIS FAMILY DENTISTRY
Practice address
2000 N Gaines Dr
Clinton, MO 64735-1132
Phone
(660) 885-6933
Fax
(660) 885-6935
NPI assigned
Jan 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

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

Authorized official

Name
Krystal GillisNPI 1477884351
Title
DDS
Phone
(660) 995-6933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2008016892 MO Primary

Addresses

Primary practice location

2000 N Gaines Dr
Clinton, MO 64735-1132

Mailing address

2000 N Gaines Dr
Clinton, MO 64735-1132
Phone (660) 885-6933

National Provider Directory

National Provider Directory
Tax ID family
Gillis Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2000 N Gaines Dr
Clinton, MO 64735
Phone (660) 885-6933

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1972992162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N GAINES DR",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351132",
            "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": "2000 N GAINES DR",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351132",
            "telephone_number": "660-885-6933",
            "fax_number": "660-885-6935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLIS FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-12",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "660-995-6933"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2008016892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.