Provider Demographics
NPI:1376568634
Name:GILBERT, LEWIS D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:D
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:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0048
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2262122300000X
WV0681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist