Healthcare Provider Details

I. General information

NPI: 1235196973
Provider Name (Legal Business Name): JAMES I GILBERT III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 NORTH MONROE AVENUE
COVINGTON VA
24426
US

IV. Provider business mailing address

229 NORTH MONROE AVENUE
COVINGTON VA
24426
US

V. Phone/Fax

Practice location:
  • Phone: 540-962-1709
  • Fax: 540-962-4854
Mailing address:
  • Phone: 540-962-1709
  • Fax: 540-962-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3727
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401003727
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: