MEDICARE: R JOSEPH GORE DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	04992	MD

General Provider Information

NPI Number	:	1760667539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R JOSEPH GORE DDS PA

Provider Business Mailing Address
First Line	:	1412 SOUTH SALISBURY BOULEVARD
Second Line	:	SUITE #4
City	:	SALISBURY
State	:	MD
Zip	:	21801
Country	:	US
Telephone Number	:	410-749-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 SOUTH SALISBURY BOULEVARD
Second Line	:	SUITE #4
City	:	SALISBURY
State	:	MD
Zip	:	21801
Country	:	US
Telephone Number	:	410-749-5115
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JOSEPH GORE
Credential	:	DDS PA
Telephone Number	:	410-749-5115

Provider Enumeration Date	:	12/29/2007
Last Update Date	:	12/29/2007

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