Provider Demographics
NPI:1093354854
Name:S. GIBREE, D.M.D., P.C.
Entity Type:Organization
Organization Name:S. GIBREE, D.M.D., P.C.
Other - Org Name:RIVERBEND VILLAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:9511 RIVERBEND VILLAGE DR STE I5
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-9124
Mailing Address - Country:US
Mailing Address - Phone:109-335-4854
Mailing Address - Fax:
Practice Address - Street 1:9511 RIVERBEND VILLAGE DR STE I5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-9124
Practice Address - Country:US
Practice Address - Phone:704-697-5908
Practice Address - Fax:980-237-9748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S. GIBREE, D.M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty