Provider Demographics
NPI:1932116167
Name:GIBSON, WILLIAM F (DDS, PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AVIGNON CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9104
Mailing Address - Country:US
Mailing Address - Phone:501-821-7651
Mailing Address - Fax:
Practice Address - Street 1:8116 CANTRELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2421
Practice Address - Country:US
Practice Address - Phone:501-224-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice