Basic Information
| Provider Information | |||||||||
| NPI: | 1750012472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBO | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2487 E 126TH ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441201047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272777620 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4071 LEE RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441282173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167270234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2022 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | RES.004521 | OH | Y | Dental Providers | Dentist | General Practice |
No ID Information.