Provider Demographics
NPI:1457349326
Name:GILBERT, BENJAMIN R (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
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 1:418 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1004
Mailing Address - Country:US
Mailing Address - Phone:907-586-1747
Mailing Address - Fax:907-586-4181
Practice Address - Street 1:418 4TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1004
Practice Address - Country:US
Practice Address - Phone:907-586-1747
Practice Address - Fax:907-586-4181
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice