Provider Demographics
NPI:1942387337
Name:GILBERT, JOSEPH BRADFORD (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRADFORD
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030A DULUTH HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5215
Mailing Address - Country:US
Mailing Address - Phone:770-963-3963
Mailing Address - Fax:770-963-2383
Practice Address - Street 1:1030A DULUTH HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5215
Practice Address - Country:US
Practice Address - Phone:770-963-3963
Practice Address - Fax:770-963-2383
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics