Provider Demographics
NPI:1821359639
Name:GAULKE DENTAL CLINIC PC
Entity Type:Organization
Organization Name:GAULKE DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GAULKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-386-2999
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031
Mailing Address - Country:US
Mailing Address - Phone:541-386-2999
Mailing Address - Fax:541-386-3726
Practice Address - Street 1:307 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2358
Practice Address - Country:US
Practice Address - Phone:541-386-2999
Practice Address - Fax:541-386-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD54011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty