MEDICARE: DR. DAVID WAYNE 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	40596	CA

General Provider Information

NPI Number	:	1487715348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WAYNE GIBSON DDS

Provider Business Mailing Address
First Line	:	1171 MURRIETA BLVD STE 101
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4143
Country	:	US
Telephone Number	:	925-455-9510
Fax Number	:	925-455-9517

Provider Business Practice Location Address
First Line	:	1171 MURRIETA BLVD STE 101
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4143
Country	:	US
Telephone Number	:	925-455-9510
Fax Number	:	925-455-9517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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