Healthcare Provider Details

I. General information

NPI: 1447550108
Provider Name (Legal Business Name): MARK MCGILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E NOB HILL BLVD
YAKIMA WA
98901-3534
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-3334
  • Fax: 509-453-6144
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00007332
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7332
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: