Healthcare Provider Details

I. General information

NPI: 1891407029
Provider Name (Legal Business Name): GORDON GILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 348TH ST STE 102
FEDERAL WAY WA
98003-7015
US

IV. Provider business mailing address

24419 106TH AVE SE
KENT WA
98030-5323
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-5501
  • Fax:
Mailing address:
  • Phone: 206-779-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61352045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: