Provider Demographics
NPI:1336346287
Name:GIBBS, DENNIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:GIBBS
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 1:701 SCOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7515
Mailing Address - Country:US
Mailing Address - Phone:661-758-7015
Mailing Address - Fax:
Practice Address - Street 1:WASCO STATE PRISON
Practice Address - Street 2:701 SCOFIELD AVE
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-8800
Practice Address - Country:US
Practice Address - Phone:661-758-8400
Practice Address - Fax:661-758-7619
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist