Provider Demographics
NPI:1144357732
Name:GORE, ROD W (DDS)
Entity type:Individual
Prefix:DR
First Name:ROD
Middle Name:W
Last Name:GORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8535 E HARTFORD DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5438
Mailing Address - Country:US
Mailing Address - Phone:480-585-6225
Mailing Address - Fax:480-585-3548
Practice Address - Street 1:8535 E HARTFORD DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5438
Practice Address - Country:US
Practice Address - Phone:480-585-6225
Practice Address - Fax:480-585-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD37671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice