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General NPI Number Information
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NPI Number | 1417389933
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Entity Type | Organization
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Legal Business Name | GILMORE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 604 E BAILEY BOSWELL RD STE 150
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City | SAGINAW
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State | TX
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Zip | 76131-3574
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Country | US
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Telephone | 817-847-9901
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Fax |
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Provider Business Mailing Address
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Address Line | 137 MERCHANTS ROW STE 121
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City | ARLINGTON
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State | TX
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Zip | 76018-6023
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Country | US
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Telephone | 817-847-9901
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Fax | 817-847-9668
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Authorized Official
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Title or Position | MEMBER/ORTHODONTIST
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Name | DR. DARRYL EUGENE GILMORE
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Credential | DDS
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Telephone | 817-847-9901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 24324
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License Number State | TX
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