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General NPI Number Information
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NPI Number | 1740312891
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Entity Type | Organization
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Legal Business Name | JAMES I GIBSON DDS MS PC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 70 E HORIZON RIDGE PKWY 170
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City | HENDERSON
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State | NV
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Zip | 89002
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Country | US
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Telephone | 702-564-1037
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Fax | 702-565-6104
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Provider Business Mailing Address
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Address Line | 70 E HORIZON RIDGE PKWY 170
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City | HENDERSON
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State | NV
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Zip | 89015-7925
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Country | US
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Telephone | 702-564-1037
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Fax | 702-565-6104
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES ISAAC GIBSON III
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Credential | DDS, MS
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Telephone | 702-564-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-97
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License Number State | NV
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