Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1277 | AK |
NPI | 1003062456 |
---|---|
Provider Name | Jeffrey W Kilgore |
First Address | Fairbanks, AK 99701-6407 |
Second Address | Fairbanks, AK 99701-6407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 27/08/2008 |