Provider Demographics
NPI:1104073485
Name:DEWHIRST, LOUISE GIBSON (DDS)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:GIBSON
Last Name:DEWHIRST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5304
Mailing Address - Country:US
Mailing Address - Phone:845-702-8133
Mailing Address - Fax:
Practice Address - Street 1:2 MAVERICK RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1714
Practice Address - Country:US
Practice Address - Phone:845-679-2421
Practice Address - Fax:845-679-3235
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047748-11223G0001X
CA310171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice