Provider Demographics
NPI:1194708453
Name:GILPIN, JERRY A (DMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:A
Last Name:GILPIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1405
Mailing Address - Country:US
Mailing Address - Phone:615-792-4238
Mailing Address - Fax:615-792-1895
Practice Address - Street 1:776 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1405
Practice Address - Country:US
Practice Address - Phone:615-792-4238
Practice Address - Fax:615-792-1895
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000005054122300000X
KY4586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN630215OtherUNITED CONCORDIA
TN3225540Medicaid
TN0104978OtherBLUE CROSS BLUE SHIELD