Individual
GILMAN PETERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
1303 W LEXINGTON AVE, WINCHESTER, KY 40391-3100
(859) 744-0677
Mailing address
25 E HIGH ST, MT STERLING, KY 40353-1267
(859) 498-6204
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7976
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7976
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
7976
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100067490
—
KY
05
—
7100071380
—
KY
Enumeration date
07/09/2008
Last updated
03/09/2011
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