Basic Information
| Provider Information | |||||||||
| NPI: | 1871042960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILTROP | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13229 N LEWIS RD | ||||||||
| Address2: | |||||||||
| City: | CLIO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484209148 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5399 N. SAGINAW STREET | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104064246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2016 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902016399 | MI | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | 2902016399 | 05 | MI | MEDICAID |