Individual provider Active NPI

Kenneth Andrew Gilbert, D.D.S.

  • General Practice Dentistry
  • Fitzgerald, GA
National Provider Identifier
1063586808
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10448 Issued in GA
Practice address
320 Benjamin H Hill Dr SW
Fitzgerald, GA 31750-8694
Phone
(229) 423-9471
NPI assigned
Nov 20, 2006
Last updated
May 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 10448 GA Primary

Addresses

Primary practice location

320 Benjamin H Hill Dr SW
Fitzgerald, GA 31750-8694

Mailing address

2300 Tanglewood Rd
Decatur, GA 30033-2016
Phone (404) 403-4839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250402002883 AL Order and Referring Only - DentistPractitioner - Dentist 3476080706
I20250806000459 GA Order and Referring Only - DentistPractitioner - Dentist 3476080706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10448GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Children and Teen Dental Group General Practice PastSince Oct 6, 2024 Accepting new patients
Children and Teen Dental Group General Practice Past Accepting new patients
Children and Teen Dental Group General Practice Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1063586808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 TANGLEWOOD RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332016",
            "telephone_number": "404-403-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BENJAMIN H HILL DR SW",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "317508694",
            "telephone_number": "229-423-9471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBERT",
        "first_name": "KENNETH",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "10448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitzgerald, GA

Sources for this page

Verify at the official NPI Registry.