Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5809 | NC |
N | 1223E0200X | Endodontist | 5809 | NY |
NPI | 1063510105 |
---|---|
Provider Name | Thomas Michael Gilbert |
First Address | Wilmington, NC 28405-7421 |
Second Address | Wilmington, NC 28405-7421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 05/03/2008 |