Basic Information
| Provider Information | |||||||||
| NPI: | 1629591540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILROY | ||||||||
| FirstName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | US ARMY DENTAL HEALTH ACTIVITY ATTN: CREDENTIALS | ||||||||
| Address2: | 1811 ARMY BLVD. | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210826 | ||||||||
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| Practice Location | |||||||||
| Address1: | USA DENTAL ACTIVITY | ||||||||
| Address2: | 1811 ARMY BLVD. | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2017 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D10690 | OR | Y | Dental Providers | Dentist |
No ID Information.