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General NPI Number Information
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NPI Number | 1114448826
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Entity Type | Individual
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Provider Name | GIBSON BARTELUS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 2830 CAMPUS WAY N STE 614
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City | LANHAM
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State | MD
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Zip | 20706-1669
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Country | US
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Telephone | 301-955-9198
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Fax |
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Provider Business Mailing Address
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Address Line | 7730 HARKINS RD APT 471
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City | LANHAM
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State | MD
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Zip | 20706-1365
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Country | US
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Telephone | 617-633-4312
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858161
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17357
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License Number State | MD
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