Provider Demographics
NPI:1346340338
Name:GILSDORF, JAMES HARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARRY
Last Name:GILSDORF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4183
Mailing Address - Country:US
Mailing Address - Phone:740-387-5180
Mailing Address - Fax:740-383-5069
Practice Address - Street 1:325 MT VERNON AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4183
Practice Address - Country:US
Practice Address - Phone:740-387-5180
Practice Address - Fax:740-383-5069
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13483OtherDENTAL LICENSE