Provider Demographics
NPI:1205001518
Name:DAVID B. MCGIBBONS ,D.D.S.,LTD
Entity Type:Organization
Organization Name:DAVID B. MCGIBBONS ,D.D.S.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-356-5330
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:STE # 500
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-356-5330
Mailing Address - Fax:703-356-7239
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:STE # 500
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-356-5330
Practice Address - Fax:703-356-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010042641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty