MEDICARE: DR. JODY ANNETTE 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	D9525	OR
2	122300000X	Dentist	26175	TX

General Provider Information

NPI Number	:	1992008932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODY ANNETTE GILL DMD

Provider Business Mailing Address
First Line	:	3779 NAVARRO WAY
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-8446
Country	:	US
Telephone Number	:	253-241-1825
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 W PRINCETON DR STE 600
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-2556
Country	:	US
Telephone Number	:	469-795-0209
Fax Number	:	469-378-3228

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

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	07/14/2022

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