Provider Demographics
NPI:1609896141
Name:GIBLIN, JAMES M (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:GIBLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LA GONDA WAY
Mailing Address - Street 2:STE. 201
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1741
Mailing Address - Country:US
Mailing Address - Phone:925-820-8686
Mailing Address - Fax:925-820-9986
Practice Address - Street 1:520 LA GONDA WAY
Practice Address - Street 2:STE. 201
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1741
Practice Address - Country:US
Practice Address - Phone:925-820-8686
Practice Address - Fax:925-820-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0334591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice