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DR. JOHN MALCOLM GILLIS DMD NPI 1083673610


NPI Information

NPI: 1083673610
Provider Name: DR. JOHN MALCOLM GILLIS, DMD
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

Organization: BANNER - UNIVERSITY PHYSICIAN SPECIALISTS LLC

PECOS Registration: Yes

Address:
1441 N 12TH ST FL 23
PHOENIX, AZ
ZIP 85006
Phone: (602) 521-5150
Get Directions

DR. John Malcolm Gillis, DMD is an oral and maxillofacial surgery dentist in Phoenix, AZ with 24 years of experience. The provider is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. John Malcolm Gillis, DMD NPI is 1083673610. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Graduation Year:2000

The provider's business location address is:

1441 N 12TH ST FL 23
PHOENIX, AZ
ZIP 85006-837
Phone: (602) 521-5150
Fax: (602) 521-5151

The NPI 1083673610 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/22/2006 and was last updated on 1/17/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial Surgery6147ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1931982MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.