Provider Demographics
NPI:1093089633
Name:GILBART DENTAL CARE OF ELLICOTT CITY LLC
Entity Type:Organization
Organization Name:GILBART DENTAL CARE OF ELLICOTT CITY LLC
Other - Org Name:GILBART DENTAL CARE OF ELLICOTT CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GILBART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-524-0463
Mailing Address - Street 1:3444 ELLICOTT CENTER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4670
Mailing Address - Country:US
Mailing Address - Phone:410-750-7580
Mailing Address - Fax:410-750-7680
Practice Address - Street 1:3444 ELLICOTT CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4670
Practice Address - Country:US
Practice Address - Phone:410-750-7580
Practice Address - Fax:410-750-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12783261QD0000X
MD12985261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental