Provider Demographics
NPI:1891865879
Name:GILES, GENE R (DDS)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:R
Last Name:GILES
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0607
Mailing Address - Country:US
Mailing Address - Phone:308-762-1820
Mailing Address - Fax:308-762-1827
Practice Address - Street 1:113 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3407
Practice Address - Country:US
Practice Address - Phone:308-762-1820
Practice Address - Fax:308-762-1827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47067230500Medicaid