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General NPI Number Information
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NPI Number | 1619097706
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Entity Type | Individual
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Provider Name | CHIANN FAN GIBSON DMD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 55 S MAIN ST SUITE 290
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City | NAPERVILLE
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State | IL
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Zip | 60540-5372
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Country | US
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Telephone | 630-357-3333
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Fax | 630-357-3334
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Provider Business Mailing Address
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Address Line | 2112 W GALENA BLVD SUITE 8
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City | AURORA
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State | IL
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Zip | 60506-3255
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Country | US
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Telephone | 630-544-1419
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Fax | 630-566-0490
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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 | 019024641
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License Number State | IL
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