Provider Demographics
NPI:1588222939
Name:GIBSON, TIMOTHY CURTIS JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CURTIS
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MYERS RD STE B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8902
Mailing Address - Country:US
Mailing Address - Phone:843-647-6052
Mailing Address - Fax:
Practice Address - Street 1:617 MYERS RD STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8902
Practice Address - Country:US
Practice Address - Phone:843-647-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113921223G0001X
SC106191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice