Provider Demographics
NPI:1508072877
Name:GIBSON, EDITH S (RDH)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:S
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-0013
Mailing Address - Country:US
Mailing Address - Phone:970-596-4458
Mailing Address - Fax:
Practice Address - Street 1:26216 HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-596-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH-904336124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist