Provider Demographics
NPI:1831123850
Name:PAUL A. GILLEY, D.D.S., INC.
Entity Type:Organization
Organization Name:PAUL A. GILLEY, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-425-2978
Mailing Address - Street 1:104 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3931
Mailing Address - Country:US
Mailing Address - Phone:304-425-2978
Mailing Address - Fax:304-487-2393
Practice Address - Street 1:104 VINE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3931
Practice Address - Country:US
Practice Address - Phone:304-425-2978
Practice Address - Fax:304-487-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137530000Medicaid