Provider Demographics
NPI:1407986532
Name:JOHN C. GILMORE, JR., D.M.D., P.A.
Entity Type:Organization
Organization Name:JOHN C. GILMORE, JR., D.M.D., P.A.
Other - Org Name:GILMORE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CONNALLY
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-476-4283
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
790060OtherUNITED CONCORDIA PROVIDER