Provider Demographics
NPI:1306205976
Name:GIBSON, KATIE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:G
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16003 CHENAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-6106
Mailing Address - Country:US
Mailing Address - Phone:501-712-5080
Mailing Address - Fax:
Practice Address - Street 1:16003 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-6106
Practice Address - Country:US
Practice Address - Phone:501-712-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist