Provider Demographics
NPI:1679135511
Name:GIBBONS, DANIELLE CHARLENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:CHARLENE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GUADALUPE ST APT 2018
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3146
Mailing Address - Country:US
Mailing Address - Phone:214-600-9110
Mailing Address - Fax:
Practice Address - Street 1:211 WALTER SEAHOLM DR # LR160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-0019
Practice Address - Country:US
Practice Address - Phone:512-877-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist