Provider Demographics
NPI:1043344252
Name:GORMLEY, JOSEPH JOHN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:GORMLEY
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 US 42
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1965
Mailing Address - Country:US
Mailing Address - Phone:859-283-5775
Mailing Address - Fax:859-283-0017
Practice Address - Street 1:7348 US 42
Practice Address - Street 2:SUITE 102
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1965
Practice Address - Country:US
Practice Address - Phone:859-283-5775
Practice Address - Fax:859-283-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist