Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7941 | AZ |
NPI | 1710208079 |
---|---|
Provider Name | Dr. Nicole C Gore |
First Address | Sheridan, WY 82801-9004 |
Second Address | Sheridan, WY 82801-9004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |