Provider Demographics
NPI:1386916211
Name:GILSON, SETH ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:ANDREW
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 1:9870 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3419
Mailing Address - Country:US
Mailing Address - Phone:954-434-2700
Mailing Address - Fax:954-434-2703
Practice Address - Street 1:9870 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3419
Practice Address - Country:US
Practice Address - Phone:954-434-2700
Practice Address - Fax:954-434-2703
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist