MEDICARE: JENNIFER SIWULA GILL DMD LLC

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	122300000X	Dentist	DS035226	PA

General Provider Information

NPI Number	:	1558618157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER SIWULA GILL DMD LLC

Provider Business Mailing Address
First Line	:	322 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1723
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

Provider Business Practice Location Address
First Line	:	322 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1723
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER SIWULA GILL
Credential	:	DMD
Telephone Number	:	724-887-4111

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/14/2012

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