Provider Demographics
NPI:1346211216
Name:GILBERT, FREDERICK BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BRYAN
Last Name:GILBERT
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 1:401B PARKHILL DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2419
Mailing Address - Country:US
Mailing Address - Phone:262-695-4623
Mailing Address - Fax:
Practice Address - Street 1:3099 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4338
Practice Address - Country:US
Practice Address - Phone:608-240-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3585-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice