Healthcare Provider Details

I. General information

NPI: 1740312891
Provider Name (Legal Business Name): JAMES I GIBSON DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E HORIZON RIDGE PKWY 170
HENDERSON NV
89002
US

IV. Provider business mailing address

70 E HORIZON RIDGE PKWY 170
HENDERSON NV
89015-7925
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-1037
  • Fax: 702-565-6104
Mailing address:
  • Phone: 702-564-1037
  • Fax: 702-565-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-97
License Number StateNV

VIII. Authorized Official

Name: DR. JAMES ISAAC GIBSON III
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 702-564-1037