Provider Demographics
NPI:1679589949
Name:GIBBS, BRUCE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:P
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 1:16620 STATE ROUTE 267
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3938
Mailing Address - Country:US
Mailing Address - Phone:330-385-1198
Mailing Address - Fax:330-385-7230
Practice Address - Street 1:16620 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3938
Practice Address - Country:US
Practice Address - Phone:330-385-1198
Practice Address - Fax:330-385-7230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice