Provider Demographics
NPI:1184771156
Name:GILBERT, ROGER NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:NEIL
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 1:11798 LANDSDOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4161
Mailing Address - Country:US
Mailing Address - Phone:909-796-1027
Mailing Address - Fax:
Practice Address - Street 1:25875 BARTON RD
Practice Address - Street 2:SUITE #104
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3891
Practice Address - Country:US
Practice Address - Phone:909-796-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA204092822Medicare UPIN