Provider Demographics
NPI:1538597158
Name:GILL, JAGDEEP SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:JAGDEEP
Middle Name:SINGH
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 1:1925 NE 35TH PL
Mailing Address - Street 2:UNIT E302
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-8019
Mailing Address - Country:US
Mailing Address - Phone:202-657-3082
Mailing Address - Fax:
Practice Address - Street 1:2921 5TH AVE NE STE 250
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7047
Practice Address - Country:US
Practice Address - Phone:253-268-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 603770831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics