Provider Demographics
NPI:1750426300
Name:GILBERT, JEFFREY R (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203
Mailing Address - Country:US
Mailing Address - Phone:205-323-7877
Mailing Address - Fax:
Practice Address - Street 1:2229 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-4233
Practice Address - Country:US
Practice Address - Phone:205-323-7877
Practice Address - Fax:205-832-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL39981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL3998OtherALABAMA DENTAL LIC