Provider Demographics
NPI:1528127685
Name:GITLIN, WILLIAM ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:GITLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17455 DOUGLAS ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1732
Mailing Address - Country:US
Mailing Address - Phone:574-243-5586
Mailing Address - Fax:574-243-5587
Practice Address - Street 1:17455 DOUGLAS ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1732
Practice Address - Country:US
Practice Address - Phone:574-243-5586
Practice Address - Fax:574-243-5587
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist