Provider Demographics
NPI:1043602386
Name:GILL ORTHODONTICS
Entity Type:Organization
Organization Name:GILL ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-232-1500
Mailing Address - Street 1:2534 UNIVERSITY DR S
Mailing Address - Street 2:SUITE #6
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5700
Mailing Address - Country:US
Mailing Address - Phone:701-232-1500
Mailing Address - Fax:701-293-6969
Practice Address - Street 1:2534 UNIVERSITY DR S
Practice Address - Street 2:SUITE #6
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5700
Practice Address - Country:US
Practice Address - Phone:701-232-1500
Practice Address - Fax:701-293-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2098261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental