Provider Demographics
NPI:1194717256
Name:STEIN, GILBERT G (DDS)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:G
Last Name:STEIN
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 1:1715 KIRBY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4320
Mailing Address - Country:US
Mailing Address - Phone:901-755-1177
Mailing Address - Fax:901-757-9571
Practice Address - Street 1:1715 KIRBY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4320
Practice Address - Country:US
Practice Address - Phone:901-755-1177
Practice Address - Fax:901-757-9571
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS21651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74211Medicare UPIN
3215199Medicare ID - Type Unspecified