Provider Demographics
NPI:1992008932
Name:GILL, JODY ANNETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ANNETTE
Last Name:GILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3779 NAVARRO WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8446
Mailing Address - Country:US
Mailing Address - Phone:253-241-1825
Mailing Address - Fax:
Practice Address - Street 1:670 W PRINCETON DR STE 600
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-2556
Practice Address - Country:US
Practice Address - Phone:469-795-0209
Practice Address - Fax:469-378-3228
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95251223G0001X
TX26175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice