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General NPI Number Information
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NPI Number | 1912080748
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Entity Type | Individual
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Provider Name | MARK W GILBERT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 6889 HIGHWAY 305 N
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2317
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Country | US
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Telephone | 662-895-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 6889 HIGHWAY 305 N
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2317
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Country | US
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Telephone | 662-895-0100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2483-89
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License Number State | MS
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