Provider Demographics
NPI:1023148335
Name:GIBBERMAN, PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:GIBBERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 LITTLE RIVER TPKE STE 205
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5100
Mailing Address - Country:US
Mailing Address - Phone:703-823-6616
Mailing Address - Fax:703-823-2141
Practice Address - Street 1:6303 LITTLE RIVER TPKE STE 205
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5100
Practice Address - Country:US
Practice Address - Phone:703-823-6616
Practice Address - Fax:703-823-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice