Provider Demographics
NPI:1396889515
Name:GIBSON, TIMOTHY DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:GIBSON
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 1:1713 E 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7100
Mailing Address - Country:US
Mailing Address - Phone:812-283-3539
Mailing Address - Fax:
Practice Address - Street 1:1713 E 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7100
Practice Address - Country:US
Practice Address - Phone:812-283-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009564A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice