Provider Demographics
NPI:1366490211
Name:GIBBONS, WILLIAM ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:GIBBONS
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 1:900 E FLORENCE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4666
Mailing Address - Country:US
Mailing Address - Phone:520-836-5468
Mailing Address - Fax:520-426-1333
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4666
Practice Address - Country:US
Practice Address - Phone:520-836-5468
Practice Address - Fax:520-426-1333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice