Provider Demographics
NPI:1346374634
Name:LEWIS D GILBERT, DDS, LTD
Entity Type:Organization
Organization Name:LEWIS D GILBERT, DDS, LTD
Other - Org Name:SOUTHWERN WEST VIRGINA ORAL & MAXILLOFACIAL SURGEONS, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-256-3777
Mailing Address - Street 1:807 BROAD ST
Mailing Address - Street 2:PO BOX 1008
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1706
Mailing Address - Country:US
Mailing Address - Phone:304-872-0300
Mailing Address - Fax:304-872-5999
Practice Address - Street 1:807 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1706
Practice Address - Country:US
Practice Address - Phone:304-872-0300
Practice Address - Fax:304-872-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2262261QS0112X
WV3691261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery