Provider Demographics
NPI:1346219581
Name:GILMER, JOHN M JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GILMER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 KAYLA ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4257
Mailing Address - Country:US
Mailing Address - Phone:318-865-5576
Mailing Address - Fax:318-865-5529
Practice Address - Street 1:275 KAYLA ST
Practice Address - Street 2:STE. 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4257
Practice Address - Country:US
Practice Address - Phone:318-865-5576
Practice Address - Fax:318-865-5529
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics