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General NPI Number Information
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NPI Number | 1811059546
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Entity Type | Individual
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Provider Name | RICHARD GORE
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Gender | Male
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4800 KAWAIHAU RD STE D
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City | KAPAA
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State | HI
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Zip | 96746-1964
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Country | US
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Telephone | 808-240-0180
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Fax | 808-822-9298
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Provider Business Mailing Address
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Address Line | PO BOX 3990
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City | LIHUE
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State | HI
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Zip | 96766
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Country | US
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Telephone | 808-240-0100
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Fax | 808-245-8867
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | CSDT-16
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License Number State | HI
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