Provider Demographics
NPI:1033283296
Name:GILL, PAULA KAYE (DMD PSC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:KAYE
Last Name:GILL
Suffix:
Gender:F
Credentials:DMD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:350 MANCHESTER SQUARE
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962
Mailing Address - Country:US
Mailing Address - Phone:606-598-7770
Mailing Address - Fax:606-598-1769
Practice Address - Street 1:350 MANCHESTER SQUARE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-598-7770
Practice Address - Fax:606-598-1769
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63011223G0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45608924Medicaid
KY60063013Medicaid