Provider Demographics
NPI:1134252646
Name:GILBERT, LARRY D (LD)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:GILBERT
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4436
Mailing Address - Country:US
Mailing Address - Phone:541-451-1660
Mailing Address - Fax:
Practice Address - Street 1:880 E GRANT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4436
Practice Address - Country:US
Practice Address - Phone:541-451-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-143900122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist