Provider Demographics
NPI:1295211092
Name:GIBSON, CHRISTOPHER B (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
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 1:120 S DENTON TAP RD # 270A
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3297
Mailing Address - Country:US
Mailing Address - Phone:972-393-7348
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD # 270A
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:972-393-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist