MEDICARE: GIBBON FAMILY DENTISTRY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972683738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIBBON FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	812 FIRST STREET BOX 459
Second Line	:
City	:	GIBBON
State	:	NE
Zip	:	68840
Country	:	US
Telephone Number	:	308-468-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 FIRST STREET BOX 459
Second Line	:
City	:	GIBBON
State	:	NE
Zip	:	68840
Country	:	US
Telephone Number	:	308-468-5500
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. JOHN R HERRMANN
Credential	:	DDS
Telephone Number	:	308-468-5500

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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Directions to “GIBBON FAMILY DENTISTRY ” Practice Location

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