MEDICARE: JENNIFER SIWULA GILL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS035226	PA

General Provider Information

NPI Number	:	1184699969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SIWULA GILL DMD

Provider Business Mailing Address
First Line	:	322 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1723
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

Provider Business Practice Location Address
First Line	:	322 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1723
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/17/2015

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