Provider Demographics
NPI:1134278781
Name:JORGE E. VALLEJO, D.M.D. & KATHLEEN GILMORE,D.M.D., L.L.P.
Entity Type:Organization
Organization Name:JORGE E. VALLEJO, D.M.D. & KATHLEEN GILMORE,D.M.D., L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-491-0505
Mailing Address - Street 1:239 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1720
Mailing Address - Country:US
Mailing Address - Phone:973-491-0505
Mailing Address - Fax:973-491-0630
Practice Address - Street 1:239 ELM ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1720
Practice Address - Country:US
Practice Address - Phone:973-491-0505
Practice Address - Fax:973-491-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ188821223G0001X
NJ188831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty