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NPI Code Detail

MEDICARE: DR. KENNETH P. GIBSON D.D.S.

MEDICARE: DR. KENNETH P. GIBSON D.D.S.
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 DentistryDN 0011452FL

General Provider Information

NPI Number : 1669503751
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH P. GIBSON D.D.S.
Provider Business Mailing Address
First Line : 1871 NE 163RD ST
Second Line :
City : NORTH MIAMI BEACH
State : FL
Zip : 33162-4805
Country : US
Telephone Number : 305-354-2213
Fax Number : 305-945-9277
Provider Business Practice Location Address
First Line : 1871 NE 163RD ST
Second Line :
City : NORTH MIAMI BEACH
State : FL
Zip : 33162-4805
Country : US
Telephone Number : 305-354-2213
Fax Number : 305-945-9277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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