Provider Demographics
NPI:1528318425
Name:KALDESTAD & GILL, PLLC
Entity type:Organization
Organization Name:KALDESTAD & GILL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-268-0097
Mailing Address - Street 1:2921 5TH AVE NE
Mailing Address - Street 2:#250
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2921 5TH AVE NE
Practice Address - Street 2:#250
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7044
Practice Address - Country:US
Practice Address - Phone:253-376-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000095741223E0200X
1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty