Provider Demographics
NPI:1528408077
Name:GILBERT, PATRICK RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RAY
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLAWAY CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2540
Mailing Address - Country:US
Mailing Address - Phone:270-782-0716
Mailing Address - Fax:270-746-9603
Practice Address - Street 1:120 CALLAWAY CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2540
Practice Address - Country:US
Practice Address - Phone:270-782-0716
Practice Address - Fax:270-746-9603
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100221223P0221X
IN12011987A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist