Provider Demographics
NPI:1912205139
Name:GIBBS, MARK BRECKENRIDGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRECKENRIDGE
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4435
Mailing Address - Country:US
Mailing Address - Phone:252-633-5544
Mailing Address - Fax:
Practice Address - Street 1:901 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4435
Practice Address - Country:US
Practice Address - Phone:252-633-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice