Individual
JACK EVERETT GORIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1821 CHASE RD, LOGANSPORT, IN 46947-1200
(574) 753-4542
(574) 722-5059
Mailing address
1821 CHASE RD, LOGANSPORT, IN 46947-1200
(574) 753-4542
(574) 722-5059
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008389
IN
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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