Provider Demographics
NPI:1750406377
Name:GILMORE, LORETTA (DDS)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LORETTA GILMORE DDS
Other - Middle Name:
Other - Last Name:LORETTA GILMORE DENTAL CORPORATION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9275 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1219
Mailing Address - Country:US
Mailing Address - Phone:909-917-4062
Mailing Address - Fax:888-713-1198
Practice Address - Street 1:9275 BASELINE RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1219
Practice Address - Country:US
Practice Address - Phone:909-945-0024
Practice Address - Fax:909-948-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery