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General NPI Number Information
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NPI Number | 1639607914
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Entity Type | Organization
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Legal Business Name | ANDREW C GIBSON DDS PLLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 4025 MECHANICSVILLE TPKE
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City | RICHMOND
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State | VA
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Zip | 23223-1117
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Country | US
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Telephone | 804-321-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 MECHANICSVILLE TPKE
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City | RICHMOND
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State | VA
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Zip | 23223-1117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. ANDREW C GIBSON
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Credential | DDS, MSD
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Telephone | 804-321-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401414509
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License Number State | VA
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