Healthcare Provider Details

I. General information

NPI: 1003081035
Provider Name (Legal Business Name): PAULA GILL, D.M.D FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MANCHESTER SQUARE SHPG CTR
MANCHESTER KY
40962-8700
US

IV. Provider business mailing address

PO BOX 157 350 MANCHESTER SQUARE
MANCHESTER KY
40962-0157
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PAULA KAYE GILL
Title or Position: OWNER
Credential: D.M.D
Phone: 606-598-7770