Healthcare Provider Details

I. General information

NPI: 1861796526
Provider Name (Legal Business Name): TANYA MARIE GIBSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST FL 3
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2133
  • Fax: 816-235-5473
Mailing address:
  • Phone: 816-235-2133
  • Fax: 816-235-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number44D2016339
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number26D0652227
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: