Individual
LIONEL A GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
350 N CLARK ST, SUITE 600, CHICAGO, IL 60654-4712
(312) 274-4524
Mailing address
350 N CLARK ST, SUITE 600, CHICAGO, IL 60654-4712
(312) 274-4524
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028820
IL
122300000X
Dentist
5864 C1
AL
122300000X
Dentist
DN014322
GA
Other
Enumeration date
07/25/2011
Last updated
09/14/2015
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