Provider Demographics
NPI:1659864122
Name:GIBBS, CHRISTOPHER KAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KAMERON
Last Name:GIBBS
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 1:1518 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2400
Mailing Address - Country:US
Mailing Address - Phone:214-532-2959
Mailing Address - Fax:
Practice Address - Street 1:2484 AVONDALE HASLET RD
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-6252
Practice Address - Country:US
Practice Address - Phone:817-439-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34014122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist