Provider Demographics
NPI:1174136006
Name:GILBERT, JEFFREY RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RYAN
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15424 FM 1825 STE 120
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3148
Mailing Address - Country:US
Mailing Address - Phone:512-595-7452
Mailing Address - Fax:
Practice Address - Street 1:15424 FM 1825 STE 120
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3148
Practice Address - Country:US
Practice Address - Phone:512-595-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist