Provider Demographics
NPI:1922138221
Name:GILGE, KEVIN J (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:GILGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:OLYMPIA
Other - Middle Name:DENTAL
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2705 LIMITED LANE N.W.
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-943-4300
Mailing Address - Fax:360-357-7968
Practice Address - Street 1:2705 LIMITED LN NW
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6504
Practice Address - Country:US
Practice Address - Phone:360-943-4300
Practice Address - Fax:360-357-7968
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice