Provider Demographics
NPI:1326490228
Name:GIBSON, AUSTIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JAMES
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S IDAHO RD
Mailing Address - Street 2:STE 260
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-2379
Mailing Address - Country:US
Mailing Address - Phone:480-982-0782
Mailing Address - Fax:
Practice Address - Street 1:110 S IDAHO RD
Practice Address - Street 2:STE 260
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-2379
Practice Address - Country:US
Practice Address - Phone:480-982-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist