Provider Demographics
NPI:1598927899
Name:GILBERT, RICHARD C (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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 1:23451 WALDEN CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4919
Mailing Address - Country:US
Mailing Address - Phone:239-948-2111
Mailing Address - Fax:239-948-2111
Practice Address - Street 1:23451 WALDEN CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4919
Practice Address - Country:US
Practice Address - Phone:239-948-2111
Practice Address - Fax:239-948-2111
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000332800Medicaid