Provider Demographics
NPI:1659539807
Name:GIBSON, WILLIAM KNOWLTON JR (DMD DENTIST)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KNOWLTON
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:DMD DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CENTRAL AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-262-1913
Mailing Address - Fax:866-832-7952
Practice Address - Street 1:850 CENTRAL AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-262-1913
Practice Address - Fax:866-832-7952
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist