Provider Demographics
NPI:1003255738
Name:GIBBS, JESSICA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5712
Mailing Address - Country:US
Mailing Address - Phone:630-858-8800
Mailing Address - Fax:630-858-3067
Practice Address - Street 1:26 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5712
Practice Address - Country:US
Practice Address - Phone:630-858-8800
Practice Address - Fax:630-858-3067
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist