MEDICARE: DR. LAUREN BETH GIBBERMAN D.D.S.

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	0401414461	VA

General Provider Information

NPI Number	:	1801208350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN BETH GIBBERMAN D.D.S.

Provider Business Mailing Address
First Line	:	6303 LITTLE RIVER TPKE
Second Line	:	SUITE 205
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5000
Country	:	US
Telephone Number	:	703-823-6616
Fax Number	:	703-823-2141

Provider Business Practice Location Address
First Line	:	6303 LITTLE RIVER TPKE
Second Line	:	SUITE 205
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5000
Country	:	US
Telephone Number	:	703-823-6616
Fax Number	:	703-823-2141

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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