Provider Demographics
NPI:1134109143
Name:GIBBS, MEYLER DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:MEYLER
Middle Name:DAVID
Last Name:GIBBS
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66968-0175
Mailing Address - Country:US
Mailing Address - Phone:785-325-2248
Mailing Address - Fax:785-325-2249
Practice Address - Street 1:300 C ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:KS
Practice Address - Zip Code:66968
Practice Address - Country:US
Practice Address - Phone:785-325-2248
Practice Address - Fax:785-325-2249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55121223G0001X
CO1040101223G0001X
WY6761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice