Provider Demographics
NPI:1871820530
Name:GIBSON & LEAVITT ORAL, MAXILLOFACIAL AND IMPLANT SURGERY
Entity Type:Organization
Organization Name:GIBSON & LEAVITT ORAL, MAXILLOFACIAL AND IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-685-3700
Mailing Address - Street 1:670 S. GREEN VALLEY PKWY #115
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-685-3700
Mailing Address - Fax:702-685-3701
Practice Address - Street 1:670 S. GREEN VALLEY PKWY #115
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-685-3700
Practice Address - Fax:702-685-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty