Provider Demographics
NPI:1396874418
Name:GADILLE, DEBORAH MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MARIE
Last Name:GADILLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BILLBRAEL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8138
Mailing Address - Country:US
Mailing Address - Phone:989-773-9437
Mailing Address - Fax:
Practice Address - Street 1:209 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WESTPHALIA
Practice Address - State:MI
Practice Address - Zip Code:48894-0240
Practice Address - Country:US
Practice Address - Phone:989-587-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010156971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice