Provider Demographics
NPI:1447926613
Name:GILBERT, EVAN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SCOTT
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 1:8947 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3153
Mailing Address - Country:US
Mailing Address - Phone:662-895-0100
Mailing Address - Fax:662-893-2703
Practice Address - Street 1:8947 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3153
Practice Address - Country:US
Practice Address - Phone:662-895-0100
Practice Address - Fax:662-893-2703
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4240-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice