1346374634 NPI number — LEWIS D GILBERT, DDS, LTD

Table of content: (NPI 1346374634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346374634 NPI number — LEWIS D GILBERT, DDS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS D GILBERT, DDS, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHWERN WEST VIRGINA ORAL & MAXILLOFACIAL SURGEONS, LTD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346374634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 BROAD ST
Provider Second Line Business Mailing Address:
PO BOX 1008
Provider Business Mailing Address City Name:
SUMMERSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26651-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-872-0300
Provider Business Mailing Address Fax Number:
304-872-5999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26651-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-872-0300
Provider Business Practice Location Address Fax Number:
304-872-5999
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
304-256-3777

Provider Taxonomy Codes

  • Taxonomy code: 261QS0112X , with the licence number:  2262 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0112X , with the licence number: 3691 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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