Provider Demographics
NPI:1598824476
Name:GORE, BOBBY GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:GENE
Last Name:GORE
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:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-0730
Mailing Address - Country:US
Mailing Address - Phone:843-797-1161
Mailing Address - Fax:843-797-1162
Practice Address - Street 1:513 RED BANK RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-4507
Practice Address - Country:US
Practice Address - Phone:843-797-1161
Practice Address - Fax:843-797-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice