Provider Demographics
NPI:1225109903
Name:GILL, JASJIT SINGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASJIT
Middle Name:SINGH
Last Name:GILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JAS
Other - Middle Name:SINGH
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:299 LINCOLN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3609
Mailing Address - Country:US
Mailing Address - Phone:508-852-0021
Mailing Address - Fax:508-852-0031
Practice Address - Street 1:299 LINCOLN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3609
Practice Address - Country:US
Practice Address - Phone:508-852-0021
Practice Address - Fax:508-852-0031
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193881223S0112X
CA533651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU99390Medicare UPIN
MAX20115Medicare ID - Type UnspecifiedMEDICARE NUMBER