Provider Demographics
NPI:1700096948
Name:GIBBONS, PAUL KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENT
Last Name:GIBBONS
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 1:33 LONO AVE
Mailing Address - Street 2:SUITE, 210
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1633
Mailing Address - Country:US
Mailing Address - Phone:808-877-3605
Mailing Address - Fax:808-871-7446
Practice Address - Street 1:33 LONO AVE
Practice Address - Street 2:SUITE, 210
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1633
Practice Address - Country:US
Practice Address - Phone:808-877-3605
Practice Address - Fax:808-871-7446
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice