Provider Demographics
NPI:1336308741
Name:MCGIBBONS, DAVID BROWN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BROWN
Last Name:MCGIBBONS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6845 ELM STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-356-5330
Mailing Address - Fax:703-356-7239
Practice Address - Street 1:6845 ELM STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-356-5330
Practice Address - Fax:703-356-7239
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist