Individual
DR. REX SHANNON GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1245 SE 3RD ST, STE #A-1, BEND, OR 97702-2161
(541) 318-5688
(541) 322-5581
Mailing address
63870 JOHNSON RD, BEND, OR 97701-5218
(541) 318-5688
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D7724
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299183
—
OR
Enumeration date
05/17/2007
Last updated
01/15/2008
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