Provider Demographics
NPI:1831483353
Name:GILSTRAP, DANIEL ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:GILSTRAP
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 1:19401 E 40 HWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5451
Mailing Address - Country:US
Mailing Address - Phone:816-795-7007
Mailing Address - Fax:
Practice Address - Street 1:19401 E 40 HWY
Practice Address - Street 2:SUITE 180
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5451
Practice Address - Country:US
Practice Address - Phone:816-795-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110144351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice