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General NPI Number Information
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NPI Number | 1073970612
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Entity Type | Organization
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Legal Business Name | DR. BRUCE P GIBBS, INC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 16620 STATE ROUTE 267
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-3938
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Country | US
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Telephone | 330-385-1198
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Fax | 330-385-7230
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Provider Business Mailing Address
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Address Line | 16620 STATE ROUTE 267
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-3938
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Country | US
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Telephone | 330-385-1198
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Fax | 330-385-7230
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE P GIBBS
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Credential | DDS
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Telephone | 330-385-1198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 15822
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License Number State | OH
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