Provider Demographics
NPI:1063510105
Name:GILBERT, THOMAS MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:GILBERT
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 1:2709 NORTHCHASE PKWY SE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-7421
Mailing Address - Country:US
Mailing Address - Phone:910-452-1696
Mailing Address - Fax:910-452-5903
Practice Address - Street 1:2709 NORTHCHASE PKWY SE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7421
Practice Address - Country:US
Practice Address - Phone:910-452-1696
Practice Address - Fax:910-452-5903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58091223E0200X
NC5809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics