Provider Demographics
NPI:1063594273
Name:GILLETTE, EDITH (DDS)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-1028
Mailing Address - Country:US
Mailing Address - Phone:406-868-1549
Mailing Address - Fax:
Practice Address - Street 1:108 VILLAGE DOWNTOWN BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3815
Practice Address - Country:US
Practice Address - Phone:406-868-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist