Healthcare Provider Details

I. General information

NPI: 1063586808
Provider Name (Legal Business Name): KENNETH ANDREW GILBERT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BENJAMIN H HILL DR SW
FITZGERALD GA
31750-8694
US

IV. Provider business mailing address

2300 TANGLEWOOD RD
DECATUR GA
30033-2016
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-9471
  • Fax:
Mailing address:
  • Phone: 404-403-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10448
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: