Provider Demographics
NPI:1578055091
Name:GILMAN, CALEB EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:EDWARD
Last Name:GILMAN
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 1:914 E COUNTY ROAD 1175 N
Mailing Address - Street 2:
Mailing Address - City:FARMERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47850-8012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8845 BOEHNING LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1974
Practice Address - Country:US
Practice Address - Phone:317-899-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012932A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist