Provider Demographics
NPI:1598999039
Name:GILMORE, DARRYL E (DDS)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:E
Last Name:GILMORE
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 1:137 MERCHANTS ROW
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 MERCHANTS ROW
Practice Address - Street 2:SUITE 121
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6022
Practice Address - Country:US
Practice Address - Phone:202-215-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics