Provider Demographics
NPI:1114903911
Name:GIBSON, WILLIAM SIDNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SIDNEY
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SPIVEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2915
Mailing Address - Country:US
Mailing Address - Phone:910-648-7741
Mailing Address - Fax:910-640-2373
Practice Address - Street 1:904 SPIVEY RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2915
Practice Address - Country:US
Practice Address - Phone:910-642-7740
Practice Address - Fax:910-640-2373
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993181Medicaid