Provider Demographics
NPI:1770757247
Name:GIBBS, IAN COREY (DMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:COREY
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S BARRINGTON AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2875
Mailing Address - Country:US
Mailing Address - Phone:215-917-6708
Mailing Address - Fax:
Practice Address - Street 1:1510 S BARRINGTON AVE APT 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2875
Practice Address - Country:US
Practice Address - Phone:215-917-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery