Provider Demographics
NPI:1568658581
Name:GIBBONS, CATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:GIBBONS
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 1:3273 E POWELL PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3457
Mailing Address - Country:US
Mailing Address - Phone:480-381-8154
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:SUITE 133
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:480-882-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD7330Medicaid