Provider Demographics
NPI:1861456170
Name:GILMORE, SHAUNA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:LYNN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 E NICHOLS PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3067
Mailing Address - Country:US
Mailing Address - Phone:303-488-9984
Mailing Address - Fax:720-529-1376
Practice Address - Street 1:6881 S HOLLY CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1145
Practice Address - Country:US
Practice Address - Phone:720-493-9242
Practice Address - Fax:720-529-1376
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice