Healthcare Provider Details

I. General information

NPI: 1326489287
Provider Name (Legal Business Name): SARAH BETH GIBBS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CYPRESS POINT PKWY SUITE 5
PALM COAST FL
32164-8455
US

IV. Provider business mailing address

85 CYPRESS POINT PKWY SUITE 5
PALM COAST FL
32164-8455
US

V. Phone/Fax

Practice location:
  • Phone: 386-283-5915
  • Fax: 386-283-5920
Mailing address:
  • Phone: 386-283-5915
  • Fax: 386-283-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN20263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: