Provider Demographics
NPI:1316962707
Name:KILGORE, ROBERT DWAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DWAYNE
Last Name:KILGORE
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:PO BOX 3937
Mailing Address - Street 2:106 WATER STREET
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-3937
Mailing Address - Country:US
Mailing Address - Phone:276-328-5291
Mailing Address - Fax:276-328-2539
Practice Address - Street 1:106 WATER STREET
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293
Practice Address - Country:US
Practice Address - Phone:276-328-5291
Practice Address - Fax:276-328-2539
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA69021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA102614OtherUNITED CONCORDIA
VA281624OtherANTHEM