Provider Demographics
NPI:1952528739
Name:FRED GILBEAUX, DDS, PC
Entity Type:Organization
Organization Name:FRED GILBEAUX, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GILBEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-492-4000
Mailing Address - Street 1:4583 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9461
Mailing Address - Country:US
Mailing Address - Phone:315-492-4000
Mailing Address - Fax:315-469-3029
Practice Address - Street 1:4583 NORTH ST
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9461
Practice Address - Country:US
Practice Address - Phone:315-492-4000
Practice Address - Fax:315-469-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty