Provider Demographics
NPI:1740312891
Name:JAMES I GIBSON DDS MS PC
Entity type:Organization
Organization Name:JAMES I GIBSON DDS MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:702-564-1037
Mailing Address - Street 1:70 E HORIZON RIDGE PKWY
Mailing Address - Street 2:170
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7925
Mailing Address - Country:US
Mailing Address - Phone:702-564-1037
Mailing Address - Fax:702-565-6104
Practice Address - Street 1:70 E HORIZON RIDGE PKWY
Practice Address - Street 2:170
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002
Practice Address - Country:US
Practice Address - Phone:702-564-1037
Practice Address - Fax:702-565-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty