Healthcare Provider Details

I. General information

NPI: 1598828428
Provider Name (Legal Business Name): BILL J GIBSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9816
US

V. Phone/Fax

Practice location:
  • Phone: 304-760-6336
  • Fax: 304-720-4813
Mailing address:
  • Phone: 304-760-6336
  • Fax: 304-720-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2220
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: