Provider Demographics
NPI:1316212277
Name:GIL, JOSE AUGUSTO (DMD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:AUGUSTO
Last Name:GIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 CHANDLER WAY
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9105
Mailing Address - Country:US
Mailing Address - Phone:857-234-0014
Mailing Address - Fax:
Practice Address - Street 1:2690 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8001
Practice Address - Country:US
Practice Address - Phone:857-234-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist