Provider Demographics
NPI:1659543726
Name:GILBERT, LAWRENCE RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RICHARD
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-0114
Mailing Address - Country:US
Mailing Address - Phone:973-366-2917
Mailing Address - Fax:973-366-2917
Practice Address - Street 1:31 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2216
Practice Address - Country:US
Practice Address - Phone:973-366-2917
Practice Address - Fax:973-366-2917
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101157400122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice