MEDICARE: L. SAMUELGILL, JR., D.D.S., M.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	1833	TN

General Provider Information

NPI Number	:	1063539393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. SAMUELGILL, JR., D.D.S., M.S., P.C.

Provider Business Mailing Address
First Line	:	105 LEE PARKWAY DR
Second Line	:	SUITE B
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6708
Country	:	US
Telephone Number	:	423-894-5978
Fax Number	:	423-894-6715

Provider Business Practice Location Address
First Line	:	105 LEE PARKWAY DR
Second Line	:	SUITE B
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6708
Country	:	US
Telephone Number	:	423-894-5978
Fax Number	:	423-894-6715

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. LESTER SAMUEL GILL JR.
Credential	:	D.D.S., M.S.
Telephone Number	:	423-894-5978

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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