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General NPI Number Information
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NPI Number | 1497979645
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Entity Type | Organization
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Legal Business Name | WILLIAM E GIPSON DDS PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 6 SO SIXTH AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2401
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Country | US
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Telephone | 708-352-1495
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Fax | 708-352-1524
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Provider Business Mailing Address
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Address Line | 6 SO SIXTH AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2401
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Country | US
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Telephone | 708-352-1495
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Fax | 708-352-1524
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | WILLIAM EUGENE GIPSON
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Credential | DDS
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Telephone | 708-352-1495
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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 | 019014566
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License Number State | IL
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