Provider Demographics
NPI:1881893717
Name:GILL, DANIEL JOHN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:GILL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22 RAVENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1538
Mailing Address - Country:US
Mailing Address - Phone:860-904-5520
Mailing Address - Fax:860-676-8242
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-674-8079
Practice Address - Fax:860-676-8242
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052166204E00000X
CT0101691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery