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Individual

MICHAEL GIBSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
424 E CENTER AVENUE, DORCHESTER, WI 54425-0236
(715) 654-5911
(715) 654-5937
Mailing address
PO BOX 236, DORCHESTER, WI 54425-0236
(715) 654-5911
(715) 654-5937

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2855
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33434800
WI
01
3432
FAMILY HEALTH CENTER
WI
Enumeration date
11/16/2006
Last updated
07/08/2007
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