MEDICARE: KATHY T. GIBSON DDS

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
1	1223G0001X	General Practice Dentistry	32229	TX

General Provider Information

NPI Number	:	1396290854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHY T. GIBSON DDS

Provider Business Mailing Address
First Line	:	8866 GULF FWY
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77017-6514
Country	:	US
Telephone Number	:	713-644-9209
Fax Number	:

Provider Business Practice Location Address
First Line	:	8866 GULF FWY
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77017-6514
Country	:	US
Telephone Number	:	713-644-9209
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	KATHY GIBSON
Credential	:	D.D.S
Telephone Number	:	713-644-9209

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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