Provider Demographics
NPI:1952490989
Name:MCGIBONY, JASON REID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:REID
Last Name:MCGIBONY
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 1:378 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5163
Mailing Address - Country:US
Mailing Address - Phone:912-764-4403
Mailing Address - Fax:912-764-7210
Practice Address - Street 1:378 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5163
Practice Address - Country:US
Practice Address - Phone:912-764-4403
Practice Address - Fax:912-764-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist