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General NPI Number Information
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NPI Number | 1275587214
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Entity Type | Organization
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Legal Business Name | EDWARD A GIBB DMD PC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 802 7TH ST
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City | OREGON CITY
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State | OR
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Zip | 97045-2324
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Country | US
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Telephone | 503-655-0613
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Fax | 503-655-3674
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Provider Business Mailing Address
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Address Line | 802 7TH ST
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City | OREGON CITY
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State | OR
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Zip | 97045-2324
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Country | US
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Telephone | 503-655-0613
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Fax | 503-655-3674
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD A GIBB
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Credential | DMD
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Telephone | 503-655-0613
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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 | 4724
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License Number State | OR
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