MEDICARE: KYLE DAVID GILL DDS

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	1223G0001X	General Practice Dentistry	DE60035223	WA

General Provider Information

NPI Number	:	1306092630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE DAVID GILL DDS

Provider Business Mailing Address
First Line	:	19145 TJERNE PL SE STE 179
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-1476
Country	:	US
Telephone Number	:	360-794-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	19145 TJERNE PL SE STE 179
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-1476
Country	:	US
Telephone Number	:	360-794-9055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	03/19/2026

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