Provider Demographics
NPI:1336332832
Name:PAUL GIBBERMAN, D.D.S. FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PAUL GIBBERMAN, D.D.S. FAMILY DENTISTRY
Other - Org Name:GIBBERMAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-823-6616
Mailing Address - Street 1:4613 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2594
Mailing Address - Country:US
Mailing Address - Phone:703-823-6616
Mailing Address - Fax:703-823-2141
Practice Address - Street 1:4613 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2594
Practice Address - Country:US
Practice Address - Phone:703-823-6616
Practice Address - Fax:703-823-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005538122300000X
VA0401411023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty