Provider Demographics
NPI:1790895910
Name:GASKILL, JULIE A (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GASKILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 PARK ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-843-6891
Mailing Address - Fax:270-843-4469
Practice Address - Street 1:546 PARK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-843-6891
Practice Address - Fax:270-843-4469
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6532122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64065329Medicaid
KY000000069019OtherANTHEM
KY60065323OtherMEDICAID DENTAL
KY000000069019OtherANTHEM
KY60065323OtherMEDICAID DENTAL