Provider Demographics
NPI:1326300740
Name:G. GIBSON MCCALL, III, DDS, MS, PLLC
Entity Type:Organization
Organization Name:G. GIBSON MCCALL, III, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:910-373-9425
Mailing Address - Street 1:1909 TURNBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6168
Mailing Address - Country:US
Mailing Address - Phone:252-353-9000
Mailing Address - Fax:
Practice Address - Street 1:1909 TURNBURY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6168
Practice Address - Country:US
Practice Address - Phone:252-353-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty