Individual
DR. KENNETH ROY GIBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
10875 MAIN ST, SUITE 206, FAIRFAX, VA 22030-4732
(703) 273-2040
(703) 273-6813
Mailing address
10875 MAIN ST, SUITE 206, FAIRFAX, VA 22030-4732
(703) 273-2040
(703) 273-6813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
05303
VA
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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