Provider Demographics
NPI:1154473601
Name:GIBBS, BOBBY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:EDWARD
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 838
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28082-0838
Mailing Address - Country:US
Mailing Address - Phone:704-938-4616
Mailing Address - Fax:704-938-4724
Practice Address - Street 1:281 S. CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083
Practice Address - Country:US
Practice Address - Phone:704-938-4616
Practice Address - Fax:704-938-4724
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993165Medicaid
NC561215102OtherFEDERAL TAX ID NUMBER