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General NPI Number Information
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NPI Number | 1679692479
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Entity Type | Individual
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Provider Name | JEFFREY GILMOR DDS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 3701 N SOUTHPORT AVE
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City | CHICAGO
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State | IL
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Zip | 60613-3718
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Country | US
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Telephone | 773-281-8989
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Fax | 773-348-2820
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Provider Business Mailing Address
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Address Line | 3706 N SOUTHPORT AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60613-3868
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Country | US
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Telephone | 312-217-2191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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