Provider Demographics
NPI:1952371171
Name:GILBERT, BRIAN J (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
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 1:5531 SUPERSTITION DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-2522
Mailing Address - Country:US
Mailing Address - Phone:505-522-8128
Mailing Address - Fax:505-526-7863
Practice Address - Street 1:2001 E LOHMAN AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3167
Practice Address - Country:US
Practice Address - Phone:505-526-4334
Practice Address - Fax:505-526-7863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM16741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice