Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 0401005780 | VA |
Y | 1223P0700X | Prosthodontist | 5810 | NC |
NPI | 1144291311 |
---|---|
Provider Name | Kent Gore |
First Address | Morehead City, NC 28557-2569 |
Second Address | Camp Lejeune, NC 28547-2511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 08/07/2007 |