Provider Demographics
NPI:1023128055
Name:DAVID H GISBORNE, DMD, PC
Entity type:Organization
Organization Name:DAVID H GISBORNE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:GISBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-266-5596
Mailing Address - Street 1:146 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4152
Mailing Address - Country:US
Mailing Address - Phone:503-266-5596
Mailing Address - Fax:503-263-1637
Practice Address - Street 1:146 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4152
Practice Address - Country:US
Practice Address - Phone:503-266-5596
Practice Address - Fax:503-263-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty