Provider Demographics
NPI:1184699969
Name:GILL, JENNIFER SIWULA (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SIWULA
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 1:322 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1723
Mailing Address - Country:US
Mailing Address - Phone:724-887-4111
Mailing Address - Fax:724-887-5582
Practice Address - Street 1:322 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1723
Practice Address - Country:US
Practice Address - Phone:724-887-4111
Practice Address - Fax:724-887-5582
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0352261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice