Provider Demographics
NPI:1730488222
Name:PELICAN LANDING DENTAL PA
Entity Type:Organization
Organization Name:PELICAN LANDING DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-948-2111
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:239-948-2155
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:239-948-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty