Provider Demographics
NPI:1265460414
Name:GILMORE, JOHN C JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:GILMORE
Suffix:JR
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 1:1759 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7145
Mailing Address - Country:US
Mailing Address - Phone:850-476-4283
Mailing Address - Fax:850-476-9709
Practice Address - Street 1:1759 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7145
Practice Address - Country:US
Practice Address - Phone:850-476-4283
Practice Address - Fax:850-476-9709
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63711223G0001X
FL156601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
789977OtherUNITED CONCORDIA PROVIDER