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General NPI Number Information
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NPI Number | 1255436531
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Entity Type | Individual
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Provider Name | ANDREW HOPKINS GIBSON DDS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 LAKE ST
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City | SALISBURY
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State | MD
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Zip | 21801
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Country | US
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Telephone | 410-334-3401
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Fax | 410-546-5090
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Provider Business Mailing Address
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Address Line | 108 EAST MAIN STREET WICOMICO COUNTY HEALTH DEPARTMENT VILLAGE DENTAL CLINIC
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City | SALISBURY
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State | MD
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Zip | 21801
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Country | US
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Telephone | 410-334-3401
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Fax | 410-546-5090
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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 | LL504
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8379
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License Number State | CO
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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 | 3615
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License Number State | WV
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