Provider Demographics
NPI:1871693010
Name:GILL, KEVIN CLYDE (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CLYDE
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 1:3315 BURKE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1825
Mailing Address - Country:US
Mailing Address - Phone:713-947-0293
Mailing Address - Fax:713-947-0600
Practice Address - Street 1:3315 BURKE RD STE 303
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1825
Practice Address - Country:US
Practice Address - Phone:713-947-0293
Practice Address - Fax:713-947-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice