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General NPI Number Information
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NPI Number | 1487715215
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Entity Type | Individual
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Provider Name | LYDIA M GIBBS ACOSTA DMD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE SANTA CRUZ #59
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-786-4180
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Fax | 787-786-5723
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Provider Business Mailing Address
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Address Line | CALLE 2 C 5 URB SANTA PAULA
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-789-7257
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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 | 1601
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License Number State | PR
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