Provider Demographics
NPI:1073609673
Name:GILE, MICHAEL A (DR)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GILE
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14715 BEL RED RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3940
Mailing Address - Country:US
Mailing Address - Phone:425-747-9141
Mailing Address - Fax:425-747-2151
Practice Address - Street 1:14715 BEL RED RD STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3940
Practice Address - Country:US
Practice Address - Phone:425-747-9141
Practice Address - Fax:425-747-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist