Provider Demographics
NPI:1982843850
Name:GILE, JASON (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GILE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 FAY AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4284
Mailing Address - Country:US
Mailing Address - Phone:858-459-0862
Mailing Address - Fax:
Practice Address - Street 1:7855 FAY AVE STE 240
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4284
Practice Address - Country:US
Practice Address - Phone:858-459-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55516122300000X, 1223S0112X
CAA113979204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery