Provider Demographics
NPI:1275587214
Name:EDWARD A GIBB DMD PC
Entity Type:Organization
Organization Name:EDWARD A GIBB DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-655-0613
Mailing Address - Street 1:802 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2324
Mailing Address - Country:US
Mailing Address - Phone:503-655-0613
Mailing Address - Fax:503-655-3674
Practice Address - Street 1:802 7TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2324
Practice Address - Country:US
Practice Address - Phone:503-655-0613
Practice Address - Fax:503-655-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty