Provider Demographics
NPI:1780794297
Name:GIBSON, RYAN C (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
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 1:670 S. GREEN VALLEY PKWY #115
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-685-3700
Mailing Address - Fax:702-685-3701
Practice Address - Street 1:670 S. GREEN VALLEY PKWY #115
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-685-3700
Practice Address - Fax:702-685-3701
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR200001581223S0112X
NVS2-1001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery