Healthcare Provider Details

I. General information

NPI: 1568592996
Provider Name (Legal Business Name): RICHARD CLAY GILBERT D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11509 SHELBYVILLE RD
LOUISVILLE KY
40243-1372
US

IV. Provider business mailing address

11509 SHELBYVILLE RD
LOUISVILLE KY
40243-1372
US

V. Phone/Fax

Practice location:
  • Phone: 502-254-3002
  • Fax:
Mailing address:
  • Phone: 502-254-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: