Provider Demographics
NPI:1982234357
Name:S. GIBREE, D.M.D., P.C.
Entity Type:Organization
Organization Name:S. GIBREE, D.M.D., P.C.
Other - Org Name:DENTAL CARE AT BEREWICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:8680 RACHEL FREEMAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-9567
Mailing Address - Country:US
Mailing Address - Phone:980-270-6511
Mailing Address - Fax:
Practice Address - Street 1:8680 RACHEL FREEMAN WAY STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-9567
Practice Address - Country:US
Practice Address - Phone:980-270-6511
Practice Address - Fax:980-321-7061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S. GIBREE, D.M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-24
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty