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General NPI Number Information
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NPI Number | 1598989568
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Entity Type | Organization
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Legal Business Name | LAURENCE O GIBBONS JR DDS PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4303 16TH STREET NW
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City | WASHINGTON
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State | DC
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Zip | 20011-7011
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Country | US
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Telephone | 202-723-2266
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Fax | 202-726-3552
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Provider Business Mailing Address
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Address Line | 4303 16TH STREET NW
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City | WASHINGTON
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State | DC
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Zip | 20011-7011
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Country | US
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Telephone | 202-723-2266
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Fax | 202-726-3552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE O GIBBONS JR.
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Credential | DDS MA
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Telephone | 202-723-2266
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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 | DEN3068
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License Number State | DC
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