Provider Demographics
NPI:1194891226
Name:GORES, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:GORES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W SILVER LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3640
Mailing Address - Country:US
Mailing Address - Phone:507-282-8222
Mailing Address - Fax:507-282-0487
Practice Address - Street 1:24 W SILVER LAKE DR NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3640
Practice Address - Country:US
Practice Address - Phone:507-282-8222
Practice Address - Fax:507-282-0487
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice