Provider Demographics
NPI:1710119896
Name:GILBREATH, TARA ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3208
Mailing Address - Country:US
Mailing Address - Phone:406-494-7080
Mailing Address - Fax:406-494-4634
Practice Address - Street 1:820 SAMPSON ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3208
Practice Address - Country:US
Practice Address - Phone:406-494-7080
Practice Address - Fax:406-494-4634
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist