Provider Demographics
NPI:1336230382
Name:MCGILL, CARL DEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DEE
Last Name:MCGILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PECOS STREET
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3061
Mailing Address - Country:US
Mailing Address - Phone:325-949-6116
Mailing Address - Fax:325-942-1905
Practice Address - Street 1:2102 PECOS STREET
Practice Address - Street 2:SUITE 12
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3061
Practice Address - Country:US
Practice Address - Phone:325-949-6116
Practice Address - Fax:325-942-1905
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice