=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528571106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DON C GILBRETH DMD LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 11/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5785 CENTENNIAL CENTER BLVD STE 180
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-395-0366
-----------------------------------------------------
Fax | 702-645-7433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5785 CENTENNIAL CENTER BLVD STE 180
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-395-0366
-----------------------------------------------------
Fax | 702-645-7433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DON C GILBRETH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 702-395-0366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0929
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0929
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------