Provider Demographics
NPI:1497035802
Name:GIBBS, SPENCE T (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCE
Middle Name:T
Last Name:GIBBS
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 1:1 JARRETT WHITE RD BLDG 320
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-2350
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD BLDG 320
Practice Address - Street 2:USA DENTAC HAWAII
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:803-751-6213
Practice Address - Fax:803-751-6886
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice