Provider Demographics
NPI:1942477609
Name:GIBBS, PAUL ROBERT (DDS MS PA)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2241
Mailing Address - Street 2:460 S MAIN ST BUILDING 300 SUITE 301
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036
Mailing Address - Country:US
Mailing Address - Phone:704-892-0644
Mailing Address - Fax:704-892-6617
Practice Address - Street 1:460 S MAIN ST
Practice Address - Street 2:BUILDING 300 SUITE 301
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-892-0644
Practice Address - Fax:704-892-6617
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics