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General NPI Number Information
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NPI Number | 1235535519
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Entity Type | Organization
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Legal Business Name | LIVERMORE DENTAL CARE
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 1171 MURRIETA BLVD SUITE 101
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City | LIVERMORE
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State | CA
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Zip | 94550-4143
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Country | US
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Telephone | 925-455-9510
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Fax | 925-455-9517
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Provider Business Mailing Address
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Address Line | 1171 MURRIETA BLVD SUITE 101
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City | LIVERMORE
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State | CA
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Zip | 94550-4143
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Country | US
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Telephone | 925-455-9510
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Fax | 925-455-9517
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID W GIBSON
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Credential | DDS
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Telephone | 925-455-9510
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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 | 4059601
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License Number State | CA
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