Healthcare Provider Details

I. General information

NPI: 1033283296
Provider Name (Legal Business Name): PAULA KAYE GILL DMD PSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MANCHESTER SQUARE
MANCHESTER KY
40962
US

IV. Provider business mailing address

PO BOX 157 350 MANCHESTER SQUARE
MANCHESTER KY
40962
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-7770
  • Fax: 606-598-1769
Mailing address:
  • Phone: 606-598-7770
  • Fax: 606-598-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6301
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number6301
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: