MEDICARE: WILLIAM F GIBSON D.D.S., P.A.

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	2691	AR

General Provider Information

NPI Number	:	1932116167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM F GIBSON D.D.S., P.A.

Provider Business Mailing Address
First Line	:	24 AVIGNON CT
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-9104
Country	:	US
Telephone Number	:	501-821-7651
Fax Number	:

Provider Business Practice Location Address
First Line	:	8116 CANTRELL RD
Second Line	:	SUITE C
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2421
Country	:	US
Telephone Number	:	501-224-5991
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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