Provider Demographics
NPI:1174626022
Name:KILGORE, LAURA ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN
Last Name:KILGORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1253
Mailing Address - Country:US
Mailing Address - Phone:765-674-4614
Mailing Address - Fax:
Practice Address - Street 1:2724 BRAVE RIFLES REGIMENT ROAD
Practice Address - Street 2:HQ USA DENTAL ACTIVITY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007127A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice