Provider Demographics
NPI:1437345071
Name:GIBSON, HOLLIS HUNTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLIS
Middle Name:HUNTER
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 1:11700 S WESTERN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4757
Mailing Address - Country:US
Mailing Address - Phone:773-233-4780
Mailing Address - Fax:773-233-4703
Practice Address - Street 1:11700 S WESTERN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4757
Practice Address - Country:US
Practice Address - Phone:773-233-4780
Practice Address - Fax:773-233-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice