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General NPI Number Information
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NPI Number | 1952086589
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Entity Type | Individual
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Provider Name | BRIAN MARK GIBBS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 130 THOMPSON POYNTER RD
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City | LONDON
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State | KY
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Zip | 40741-7280
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Country | US
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Telephone | 606-877-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 203A BLACK ST
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City | BARBOURVILLE
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State | KY
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Zip | 40906-1478
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Country | US
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Telephone | 606-309-1938
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Fax |
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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 | 10934
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License Number State | KY
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