Provider Demographics
NPI:1174775613
Name:GIBSON, INDIA D (DDS)
Entity type:Individual
Prefix:MISS
First Name:INDIA
Middle Name:D
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 HIGHWAY 90A STE 290
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3597
Mailing Address - Country:US
Mailing Address - Phone:832-930-7858
Mailing Address - Fax:832-939-8171
Practice Address - Street 1:7320 HIGHWAY 90A STE 290
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3597
Practice Address - Country:US
Practice Address - Phone:832-930-7858
Practice Address - Fax:832-939-8171
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5931OtherLA STATE LICENSE
TX24202OtherTEXAS STATE LICENSE