MEDICARE: JUDITH GILL

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	124Q00000X	Dental Hygienist		CO

General Provider Information

NPI Number	:	1902447378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH GILL

Provider Business Mailing Address
First Line	:	7225 DANDELION CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3620
Country	:	US
Telephone Number	:	530-903-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	5426 N ACADEMY BLVD STE 105
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3686
Country	:	US
Telephone Number	:	719-249-4760
Fax Number	:

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

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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