Provider Demographics
NPI:1265659437
Name:JASON R. MCGIBONY, DMD PC
Entity Type:Organization
Organization Name:JASON R. MCGIBONY, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:REID
Authorized Official - Last Name:MCGIBONY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-764-4403
Mailing Address - Street 1:378 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5163
Mailing Address - Country:US
Mailing Address - Phone:912-764-4403
Mailing Address - Fax:912-764-7210
Practice Address - Street 1:378 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5163
Practice Address - Country:US
Practice Address - Phone:912-764-4403
Practice Address - Fax:912-764-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty