Provider Demographics
NPI:1780492959
Name:JESSICA LYNN GIBBS, DDS, P.C.
Entity type:Organization
Organization Name:JESSICA LYNN GIBBS, DDS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-452-1281
Mailing Address - Street 1:26 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5712
Mailing Address - Country:US
Mailing Address - Phone:630-858-8800
Mailing Address - Fax:
Practice Address - Street 1:26 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5712
Practice Address - Country:US
Practice Address - Phone:630-858-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental