Provider Demographics
NPI:1093363905
Name:GILBERT DENTAL CORPORATION
Entity Type:Organization
Organization Name:GILBERT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-463-9006
Mailing Address - Street 1:1101 N NORMA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-463-9006
Mailing Address - Fax:
Practice Address - Street 1:1101 N NORMA ST
Practice Address - Street 2:SUITE B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555
Practice Address - Country:US
Practice Address - Phone:760-463-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILBERT DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-04
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty