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General NPI Number Information
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NPI Number | 1063539393
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Entity Type | Organization
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Legal Business Name | L. SAMUELGILL, JR., D.D.S., M.S., P.C.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 LEE PARKWAY DR SUITE B
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6708
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Country | US
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Telephone | 423-894-5978
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Fax | 423-894-6715
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Provider Business Mailing Address
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Address Line | 105 LEE PARKWAY DR SUITE B
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6708
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Country | US
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Telephone | 423-894-5978
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Fax | 423-894-6715
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. LESTER SAMUEL GILL JR.
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Credential | D.D.S., M.S.
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Telephone | 423-894-5978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1833
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License Number State | TN
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