Provider Demographics
NPI:1477715886
Name:GILBERT, DANIEL THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
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 1:2707 VINE ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1949
Mailing Address - Country:US
Mailing Address - Phone:785-628-6469
Mailing Address - Fax:785-628-2150
Practice Address - Street 1:2707 VINE ST
Practice Address - Street 2:SUITE #3
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1949
Practice Address - Country:US
Practice Address - Phone:785-628-6469
Practice Address - Fax:785-628-2150
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89531876Medicaid