Individual
DR. ROLAND M GIBSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1411 E 53RD ST, 2ND FLOOR, CHICAGO, IL 60615-4542
(773) 947-9060
Mailing address
1411 E 53RD ST, 2ND FLOOR, CHICAGO, IL 60615-4542
(773) 947-9060
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029214
IL
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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