| Entity Name: | JOHN C. GILMORE, JR., D.M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Jan 1977 (48 years ago) |
| Document Number: | 525231 |
| FEI/EIN Number | 591783017 |
| Address: | 1759 CREIGHTON RD, PENSACOLA, FL, 32504, US |
| Mail Address: | 1759 CREIGHTON RD, PENSACOLA, FL, 32504, US |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407986532 | 2007-03-07 | 2008-06-16 | 1759 CREIGHTON RD, PENSACOLA, FL, 325047145, US | 1759 CREIGHTON RD, PENSACOLA, FL, 325047145, US | |||||||||||||||||||||||
|
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| Phone | +1 850-476-4283 |
| Fax | 8504769709 |
Authorized person
| Name | DR. JOHN CONNALLY GILMORE JR. |
| Role | PRESIDENT, DENTIST |
| Phone | 8504764283 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 6371 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA PROVIDER |
| Number | 790060 |
| Name | Role | Address |
|---|---|---|
| C GILMORE BRUCE | Agent | 1759 CREIGHTON ROAD, PENSACOLA, FL, 32504 |
| Name | Role | Address |
|---|---|---|
| GILMORE BRUCE C | PART | 1759 CREIGHTON RD, PENSACOLA, FL, 32504 |
| Oberhausen Ryan M | PART | 1759 CREIGHTON RD, PENSACOLA, FL, 32504 |
| Name | Role | Address |
|---|---|---|
| GILMORE ALLISON W | Director | 1759 CREIGHTON RD, PENSACOLA, FL, 32504 |
| Name | Role | Address |
|---|---|---|
| GILMORE ALLISON W | Secretary | 1759 CREIGHTON RD, PENSACOLA, FL, 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2015-12-23 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
