Provider Demographics
NPI:1487015277
Name:GILBERT, JOSHUA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S CANAL ST
Mailing Address - Street 2:APT 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3906
Mailing Address - Country:US
Mailing Address - Phone:847-828-3609
Mailing Address - Fax:
Practice Address - Street 1:1964 SHERIDAN RD
Practice Address - Street 2:SUITE #22
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2549
Practice Address - Country:US
Practice Address - Phone:847-828-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0027761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics