Healthcare Provider Details

I. General information

NPI: 1306205976
Provider Name (Legal Business Name): KATIE G GIBSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16003 CHENAL PKWY
LITTLE ROCK AR
72223-6106
US

IV. Provider business mailing address

16003 CHENAL PKWY
LITTLE ROCK AR
72223-6106
US

V. Phone/Fax

Practice location:
  • Phone: 501-712-5080
  • Fax:
Mailing address:
  • Phone: 501-712-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4250
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: