Provider Demographics
NPI:1477531739
Name:GILBERTS, MARK DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:GILBERTS
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 1:3001A SIXTH ST
Mailing Address - Street 2:NAVAL HOSPITAL GREAT LAKES
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-5211
Mailing Address - Country:US
Mailing Address - Phone:847-688-2100
Mailing Address - Fax:847-688-5995
Practice Address - Street 1:3001 A SIXTH ST
Practice Address - Street 2:NAVAL HOSPITAL GREAT LAKES
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5211
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:847-688-5995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2326-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice