Provider Demographics
NPI:1164507398
Name:GIBSON, DAVID BURTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BURTON
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5707
Mailing Address - Country:US
Mailing Address - Phone:256-237-0603
Mailing Address - Fax:256-237-0908
Practice Address - Street 1:313 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5707
Practice Address - Country:US
Practice Address - Phone:256-237-0603
Practice Address - Fax:256-237-0908
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL586462OtherUCCI
AL51091030OtherBCBS OF ALABAMA