Provider Demographics
NPI:1063630713
Name:DE BIASI, GILBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:DE BIASI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5722
Mailing Address - Country:US
Mailing Address - Phone:804-784-3551
Mailing Address - Fax:
Practice Address - Street 1:1954 RIVER ROAD WEST
Practice Address - Street 2:
Practice Address - City:STATE FARM
Practice Address - State:VA
Practice Address - Zip Code:23160
Practice Address - Country:US
Practice Address - Phone:804-784-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010023281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice