MEDICARE: STEVE GIBBS DDS PC

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	122300000X	Dentist	DD1067	NM

General Provider Information

NPI Number	:	1841311180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE GIBBS DDS PC

Provider Business Mailing Address
First Line	:	2010 BOTULPH RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5730
Country	:	US
Telephone Number	:	505-983-1312
Fax Number	:	505-983-8170

Provider Business Practice Location Address
First Line	:	2010 BOTULPH RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5730
Country	:	US
Telephone Number	:	505-983-1312
Fax Number	:	505-983-8170

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. STEVE WALTER GIBBS
Credential	:	DDS
Telephone Number	:	505-983-1312

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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