Provider Demographics
NPI:1598989568
Name:LAURENCE O GIBBONS JR DDS PC
Entity Type:Organization
Organization Name:LAURENCE O GIBBONS JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MA
Authorized Official - Phone:202-723-2266
Mailing Address - Street 1:4303 16TH STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7011
Mailing Address - Country:US
Mailing Address - Phone:202-723-2266
Mailing Address - Fax:202-726-3552
Practice Address - Street 1:4303 16TH STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7011
Practice Address - Country:US
Practice Address - Phone:202-723-2266
Practice Address - Fax:202-726-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN3068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty