Healthcare Provider Details

I. General information

NPI: 1164341475
Provider Name (Legal Business Name): GILL DENTAL HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 7TH ST
PERU IN
46970-2130
US

IV. Provider business mailing address

1455 STONEHAVEN DR
WESTFIELD IN
46074-1201
US

V. Phone/Fax

Practice location:
  • Phone: 765-473-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PARKER GILL
Title or Position: PRINCIPAL
Credential: DDS
Phone: 812-483-8568