Provider Demographics
NPI:1598050247
Name:GIMLIN, DENNIS RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
Last Name:GIMLIN
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 1:3238 SHALIMAR TER
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1511
Mailing Address - Country:US
Mailing Address - Phone:719-248-2438
Mailing Address - Fax:
Practice Address - Street 1:3238 SHALIMAR TER
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1511
Practice Address - Country:US
Practice Address - Phone:719-248-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics