Provider Demographics
NPI:1659003143
Name:S. GIBREE, D.M.D., P.C.
Entity Type:Organization
Organization Name:S. GIBREE, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:3830 CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1911
Mailing Address - Country:US
Mailing Address - Phone:910-756-4041
Mailing Address - Fax:910-756-4042
Practice Address - Street 1:3830 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1911
Practice Address - Country:US
Practice Address - Phone:910-756-4041
Practice Address - Fax:910-756-4042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S. GIBREE, D.M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty