Healthcare Provider Details

I. General information

NPI: 1366552085
Provider Name (Legal Business Name): JAMES R GILL DDS MSD INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7244 E VIRGINIA STREET
EVANSVILLE IN
47715-4068
US

IV. Provider business mailing address

7244 E VIRGINIA STREET
EVANSVILLE IN
47715-4068
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-1377
  • Fax: 812-476-1288
Mailing address:
  • Phone: 812-476-1377
  • Fax: 812-476-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009709
License Number StateIN

VIII. Authorized Official

Name: JAMES R GILL
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 812-476-1377