Provider Demographics
NPI:1184859373
Name:GIBSON, TERI ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:ANN
Last Name:GIBSON
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 1:10845 LINDBROOK DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3042
Mailing Address - Country:US
Mailing Address - Phone:310-824-1865
Mailing Address - Fax:310-824-8886
Practice Address - Street 1:10845 LINDBROOK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3042
Practice Address - Country:US
Practice Address - Phone:310-824-1865
Practice Address - Fax:310-824-8886
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist