Provider Demographics
NPI:1821210543
Name:GILBERT, GARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
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 1:312 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2547
Mailing Address - Country:US
Mailing Address - Phone:586-469-6336
Mailing Address - Fax:586-469-1535
Practice Address - Street 1:312 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2547
Practice Address - Country:US
Practice Address - Phone:586-469-6336
Practice Address - Fax:586-469-1535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist