Provider Demographics
NPI:1477720217
Name:AMTHOR, GILBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:M
Last Name:AMTHOR
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 1:151 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1607
Mailing Address - Country:US
Mailing Address - Phone:760-922-7777
Mailing Address - Fax:760-922-9367
Practice Address - Street 1:151 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1607
Practice Address - Country:US
Practice Address - Phone:760-922-7777
Practice Address - Fax:760-922-9367
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice