Provider Demographics
NPI:1477904498
Name:GILBERT, ELIZA JANEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:JANEEN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 MALLARD CREEK RD
Mailing Address - Street 2:APT 1116
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5812
Mailing Address - Country:US
Mailing Address - Phone:270-350-0920
Mailing Address - Fax:
Practice Address - Street 1:8517 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5301
Practice Address - Country:US
Practice Address - Phone:502-966-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist