Provider Demographics
NPI:1326227737
Name:GORE, EDITH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:M
Last Name:GORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 AMICKS FERRY RD.
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036
Mailing Address - Country:US
Mailing Address - Phone:803-345-5811
Mailing Address - Fax:803-345-5814
Practice Address - Street 1:137 AMICKS FERRY RD.
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-345-5811
Practice Address - Fax:803-345-5814
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC38051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice