Healthcare Provider Details

I. General information

NPI: 1962462853
Provider Name (Legal Business Name): RICHARD F. GILL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 GATORLAND DR
ORLANDO FL
32837-6915
US

IV. Provider business mailing address

14500 GATORLAND DR
ORLANDO FL
32837-6915
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-0800
  • Fax: 407-857-5847
Mailing address:
  • Phone: 407-857-0800
  • Fax: 407-857-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 10053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: