Provider Demographics
NPI:1588278931
Name:GILLARD, TRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:
Last Name:GILLARD
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 1:13575 W INDIAN SCHOOL RD STE 600
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4925
Mailing Address - Country:US
Mailing Address - Phone:623-932-1300
Mailing Address - Fax:
Practice Address - Street 1:13575 W INDIAN SCHOOL RD STE 600
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4925
Practice Address - Country:US
Practice Address - Phone:623-932-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist