Provider Demographics
NPI:1609069988
Name:GIBBERMAN, AVI BENJAMIN (DDS)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:BENJAMIN
Last Name:GIBBERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AVI
Other - Middle Name:BENJAMIN
Other - Last Name:GIBBERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4616 DUKE STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-823-6616
Mailing Address - Fax:703-823-2141
Practice Address - Street 1:4613 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2594
Practice Address - Country:US
Practice Address - Phone:703-823-6616
Practice Address - Fax:703-823-2141
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist