Healthcare Provider Details

I. General information

NPI: 1528408077
Provider Name (Legal Business Name): PATRICK RAY GILBERT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CALLAWAY CT
BOWLING GREEN KY
42103-2540
US

IV. Provider business mailing address

120 CALLAWAY CT
BOWLING GREEN KY
42103-2540
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-0716
  • Fax: 270-746-9603
Mailing address:
  • Phone: 270-782-0716
  • Fax: 270-746-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12011987A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10022
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: