Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1833 | TN |
NPI | 1003932674 |
---|---|
Provider Name | Dr. Lester Samuel Gill JR. |
First Address | Chattanooga, TN 37421-6708 |
Second Address | Chattanooga, TN 37421-6708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |