Provider Demographics
NPI:1336793488
Name:GILL, HARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:GILL
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 1:605 S SHELLY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6570
Mailing Address - Country:US
Mailing Address - Phone:559-355-0116
Mailing Address - Fax:
Practice Address - Street 1:5492 N PALM AVE STE A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1960
Practice Address - Country:US
Practice Address - Phone:559-900-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist