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General NPI Number Information
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NPI Number | 1386882215
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Entity Type | Organization
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Legal Business Name | GLENN E. GIBSON, DDS
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 885 CANARIOS CT 204
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City | CHULA VISTA
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State | CA
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Zip | 91910-7877
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Country | US
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Telephone | 619-216-9900
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Fax | 619-216-9461
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Provider Business Mailing Address
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Address Line | 885 CANARIOS CT 204
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City | CHULA VISTA
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State | CA
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Zip | 91910-7877
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Country | US
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Telephone | 619-216-9900
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Fax | 619-216-9461
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN E GIBSON
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Credential | DDS
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Telephone | 619-216-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33091
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License Number State | CA
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