Healthcare Provider Details

I. General information

NPI: 1588815476
Provider Name (Legal Business Name): KEVIN WESLEY GILCHRIST D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SIX FORKS RD
RALEIGH NC
27615-2980
US

IV. Provider business mailing address

7800 SIX FORKS RD
RALEIGH NC
27615-2980
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-5437
  • Fax: 919-870-7471
Mailing address:
  • Phone: 919-847-5437
  • Fax: 919-870-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8164
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: