Provider Demographics
NPI:1952549347
Name:GORE, MICHAEL SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:GORE
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 1:14431 SOMMERVILLE COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-794-4588
Mailing Address - Fax:804-378-3717
Practice Address - Street 1:14431 SOMMERVILLE CT
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6812
Practice Address - Country:US
Practice Address - Phone:804-794-4588
Practice Address - Fax:804-378-3717
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist