Provider Demographics
NPI:1063554764
Name:GILSON, STEVEN M (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:GILSON
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 1:12160 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2830
Mailing Address - Country:US
Mailing Address - Phone:954-476-0794
Mailing Address - Fax:
Practice Address - Street 1:1127 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3322
Practice Address - Country:US
Practice Address - Phone:954-424-4600
Practice Address - Fax:954-424-4339
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00098531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice