Provider Demographics
NPI:1275084626
Name:JEFFREY W. KILGORE DMD PC
Entity Type:Organization
Organization Name:JEFFREY W. KILGORE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-452-1866
Mailing Address - Street 1:1919 LATHROP ST
Mailing Address - Street 2:STE: 211
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5937
Mailing Address - Country:US
Mailing Address - Phone:907-452-1866
Mailing Address - Fax:907-456-1267
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:STE: 211
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5937
Practice Address - Country:US
Practice Address - Phone:907-452-1866
Practice Address - Fax:907-456-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty