Provider Demographics
NPI:1639416621
Name:BRET B. GILSDORF, DDS, LLC
Entity Type:Organization
Organization Name:BRET B. GILSDORF, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:GILSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-539-2314
Mailing Address - Street 1:1110 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2859
Mailing Address - Country:US
Mailing Address - Phone:785-539-2314
Mailing Address - Fax:785-539-2314
Practice Address - Street 1:1110 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2859
Practice Address - Country:US
Practice Address - Phone:785-539-2314
Practice Address - Fax:785-539-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty