Provider Demographics
NPI:1063539393
Name:L. SAMUELGILL, JR., D.D.S., M.S., P.C.
Entity type:Organization
Organization Name:L. SAMUELGILL, JR., D.D.S., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:423-894-5978
Mailing Address - Street 1:105 LEE PARKWAY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6708
Mailing Address - Country:US
Mailing Address - Phone:423-894-5978
Mailing Address - Fax:423-894-6715
Practice Address - Street 1:105 LEE PARKWAY DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6708
Practice Address - Country:US
Practice Address - Phone:423-894-5978
Practice Address - Fax:423-894-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty