Provider Demographics
NPI:1013073378
Name:KINGRY, GIPSON MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:GIPSON
Middle Name:MARK
Last Name:KINGRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8101 SEATON PL.
Mailing Address - Street 2:STE. A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7205
Mailing Address - Country:US
Mailing Address - Phone:334-272-4900
Mailing Address - Fax:334-409-9933
Practice Address - Street 1:8101 SEATON PL.
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7205
Practice Address - Country:US
Practice Address - Phone:334-272-4900
Practice Address - Fax:334-409-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL44401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics