Provider Demographics
NPI:1275573917
Name:GIBSON, KURT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALAN
Last Name:GIBSON
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:PO BOX 1589
Mailing Address - Street 2:1734 N. ROOSEVELT ST.
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1589
Mailing Address - Country:US
Mailing Address - Phone:580-338-7210
Mailing Address - Fax:
Practice Address - Street 1:1734 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2730
Practice Address - Country:US
Practice Address - Phone:580-338-7210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice