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General NPI Number Information
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NPI Number | 1043388234
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Entity Type | Individual
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Provider Name | WILLIAM BURLIN GIBSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR SUITE 2-O
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City | HAZARD
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State | KY
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Zip | 41701-9466
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Country | US
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Telephone | 606-487-0088
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Fax | 606-487-1849
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Provider Business Mailing Address
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Address Line | 10447 DRYHILL ROAD
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City | CONFLUENCE
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State | KY
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Zip | 41749
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Country | US
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Telephone | 606-672-2075
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Fax | 606-487-1849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 7055
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7055
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7055
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License Number State | KY
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