Healthcare Provider Details

I. General information

NPI: 1972687267
Provider Name (Legal Business Name): RAYMOND HARLAN GILBERT III DMD,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 2C
ALBUQUERQUE NM
87111-2069
US

IV. Provider business mailing address

8400 OSUNA RD NE STE 2C
ALBUQUERQUE NM
87111-2069
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-2332
  • Fax:
Mailing address:
  • Phone: 505-293-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberNM1440
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1440
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: