Provider Demographics
NPI:1639654924
Name:DALLA GILL DENTAL INC
Entity Type:Organization
Organization Name:DALLA GILL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-427-6519
Mailing Address - Street 1:58 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3012
Mailing Address - Country:US
Mailing Address - Phone:646-546-6374
Mailing Address - Fax:
Practice Address - Street 1:58 W COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3012
Practice Address - Country:US
Practice Address - Phone:646-546-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental