Healthcare Provider Details

I. General information

NPI: 1598999039
Provider Name (Legal Business Name): DARRYL E GILMORE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MERCHANTS ROW SUITE 121
ARLINGTON TX
76018-6022
US

IV. Provider business mailing address

137 MERCHANTS ROW SUITE 121
ARLINGTON TX
76018-6022
US

V. Phone/Fax

Practice location:
  • Phone: 202-215-6622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number24324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: