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NPI Code Detail

MEDICARE: LEVA DARRYLE GIBSON DDS

MEDICARE: LEVA DARRYLE GIBSON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2844OK

General Provider Information

NPI Number : 1568550556
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEVA DARRYLE GIBSON DDS
Provider Business Mailing Address
First Line : 405 S OKLAHOMA AVE
Second Line :
City : CHEROKEE
State : OK
Zip : 73728-2545
Country : US
Telephone Number : 580-596-2800
Fax Number : 580-596-2805
Provider Business Practice Location Address
First Line : 405 S OKLAHOMA AVE
Second Line :
City : CHEROKEE
State : OK
Zip : 73728-2545
Country : US
Telephone Number : 580-596-2800
Fax Number : 580-596-2805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 03/31/2011

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Directions to “ LEVA DARRYLE GIBSON DDS” Practice Location

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