Healthcare Provider Details

I. General information

NPI: 1013521400
Provider Name (Legal Business Name): DAVID A GORE DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S GRANITE AVE
GRANITE FALLS WA
98252-8474
US

IV. Provider business mailing address

405 S GRANITE AVE
GRANITE FALLS WA
98252-8474
US

V. Phone/Fax

Practice location:
  • Phone: 918-766-5312
  • Fax:
Mailing address:
  • Phone: 360-691-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID GORE
Title or Position: DENTIST, OWNER
Credential: DDS
Phone: 918-766-5312