Provider Demographics
NPI:1598227811
Name:LESLEY K. GILBERT DDS, LLC
Entity type:Organization
Organization Name:LESLEY K. GILBERT DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-462-7223
Mailing Address - Street 1:1852 FIELDS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-4006
Mailing Address - Country:US
Mailing Address - Phone:317-462-7223
Mailing Address - Fax:317-467-8744
Practice Address - Street 1:1852 FIELDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-4006
Practice Address - Country:US
Practice Address - Phone:317-462-7223
Practice Address - Fax:317-467-8744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LESLEY K GILBERT DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100127800AMedicaid
1760977896OtherNPI TYPE 1
IN300015694Medicaid
IN1366494726OtherNPI TYPE 1
IN300025112Medicaid
IN300025678Medicaid