Provider Demographics
NPI:1952086589
Name:GIBBS, BRIAN MARK (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARK
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 1:203A BLACK ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1478
Mailing Address - Country:US
Mailing Address - Phone:606-309-1938
Mailing Address - Fax:
Practice Address - Street 1:130 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7280
Practice Address - Country:US
Practice Address - Phone:606-877-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist