Provider Demographics
NPI:1831219955
Name:GILBERT, KEITH ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
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 1:11906 DARNESTOWN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2200
Mailing Address - Country:US
Mailing Address - Phone:301-527-0775
Mailing Address - Fax:301-527-0189
Practice Address - Street 1:11906 DARNESTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2200
Practice Address - Country:US
Practice Address - Phone:301-527-0775
Practice Address - Fax:301-527-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9617OtherDENTAL LICENSE