Provider Demographics
NPI:1275824872
Name:PETTIS, GAIL Y (DDS, MMEDSC)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:Y
Last Name:PETTIS
Suffix:
Gender:F
Credentials:DDS, MMEDSC
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 1405
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1405
Mailing Address - Country:US
Mailing Address - Phone:425-830-3255
Mailing Address - Fax:
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:#205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-351-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist