Provider Demographics
NPI:1972687267
Name:GILBERT, RAYMOND HARLAN III (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HARLAN
Last Name:GILBERT
Suffix:III
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 1:8400 OSUNA RD NE STE 2C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2069
Mailing Address - Country:US
Mailing Address - Phone:505-293-2332
Mailing Address - Fax:
Practice Address - Street 1:8400 OSUNA RD NE STE 2C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2069
Practice Address - Country:US
Practice Address - Phone:505-293-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM14401223X0400X
NM14401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics