Provider Demographics
NPI:1942710058
Name:GILMORE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:GILMORE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-364-7502
Mailing Address - Street 1:762 HIGH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2440
Mailing Address - Country:US
Mailing Address - Phone:503-364-7502
Mailing Address - Fax:503-364-1254
Practice Address - Street 1:762 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2440
Practice Address - Country:US
Practice Address - Phone:503-364-7502
Practice Address - Fax:503-364-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty