Provider Demographics
NPI:1760667539
Name:R JOSEPH GORE DDS PA
Entity Type:Organization
Organization Name:R JOSEPH GORE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:410-749-5115
Mailing Address - Street 1:1412 SOUTH SALISBURY BOULEVARD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-749-5115
Mailing Address - Fax:
Practice Address - Street 1:1412 SOUTH SALISBURY BOULEVARD
Practice Address - Street 2:SUITE #4
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-749-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD049921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty