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NPI Code Detail

MEDICARE: GARY R GIBBS

MEDICARE:   GARY R GIBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD4968AZ

General Provider Information

NPI Number : 1043259864
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY R GIBBS
Provider Business Mailing Address
First Line : 14044 W CAMELBACK RD
Second Line : SUITE 200
City : LITCHFIELD PARK
State : AZ
Zip : 85340-9428
Country : US
Telephone Number : 623-535-5488
Fax Number : 623-535-5935
Provider Business Practice Location Address
First Line : 14044 W CAMELBACK RD
Second Line : SUITE 200
City : LITCHFIELD PARK
State : AZ
Zip : 85340-9428
Country : US
Telephone Number : 623-535-5488
Fax Number : 623-535-5935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 10/19/2010

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