Provider Demographics
NPI:1043259864
Name:GIBBS, GARY R
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:GIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14044 W CAMELBACK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9428
Mailing Address - Country:US
Mailing Address - Phone:623-535-5488
Mailing Address - Fax:623-535-5935
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-535-5488
Practice Address - Fax:623-535-5935
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist