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General NPI Number Information
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NPI Number | 1265835177
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Entity Type | Organization
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Legal Business Name | GILBRETH GROUP LLC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 4111 BARBARA LOOP SE STE B
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City | RIO RANCHO
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State | NM
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Zip | 87124-1068
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Country | US
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Telephone | 505-903-6916
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Fax | 505-903-7188
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Provider Business Mailing Address
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Address Line | 4111 BARBARA LOOP SE STE B
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City | RIO RANCHO
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State | NM
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Zip | 87124-1068
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Country | US
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Telephone | 505-903-6916
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Fax | 505-903-7188
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN BRIAN GILBRETH
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Credential | D.D.S M.S.
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Telephone | 505-903-6916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DD3973
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License Number State | NM
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