Healthcare Provider Details

I. General information

NPI: 1508959412
Provider Name (Legal Business Name): DAVID GILMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 POWHATAN DR
POQUOSON VA
23662-1420
US

IV. Provider business mailing address

PO BOX 2097
POQUOSON VA
23662-0097
US

V. Phone/Fax

Practice location:
  • Phone: 757-969-2164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410519
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: