Provider Demographics
NPI:1922238393
Name:GILBERT, LACY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LACY
Middle Name:LYNN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LACY
Other - Middle Name:LYNN
Other - Last Name:HOLZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27695 BAY POINT LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3917
Mailing Address - Country:US
Mailing Address - Phone:239-218-6071
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice