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NPI Code Detail

MEDICARE: JOHN GILL

MEDICARE: JOHN 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
11223P0221XPediatric DentistryDE60147516WA

General Provider Information

NPI Number : 1922097625
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN GILL
Provider Business Mailing Address
First Line : 7501 W DESCHUTES PL
Second Line :
City : KENNEWICK
State : WA
Zip : 99336-7719
Country : US
Telephone Number : 509-783-1960
Fax Number : 509-783-7576
Provider Business Practice Location Address
First Line : 7501 W DESCHUTES PL
Second Line :
City : KENNEWICK
State : WA
Zip : 99336-7719
Country : US
Telephone Number : 509-783-1960
Fax Number : 509-783-7576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 03/18/2021

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