Provider Demographics
NPI:1265643381
Name:GIBBONS, TROY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:L
Last Name:GIBBONS
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 1:6630 EXCHANGE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2310
Mailing Address - Country:US
Mailing Address - Phone:770-968-1710
Mailing Address - Fax:770-968-3329
Practice Address - Street 1:6630 EXCHANGE PL
Practice Address - Street 2:SUITE A
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2310
Practice Address - Country:US
Practice Address - Phone:770-968-1710
Practice Address - Fax:770-968-3329
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist