Individual
DR. HARRY E GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1149 BOUGHTON ST BLDG B, WATERTOWN, WI 53094-3104
(920) 261-0495
(920) 261-3632
Mailing address
1149 BOUGHTON ST BLDG B, WATERTOWN, WI 53094-3104
(920) 261-0495
(920) 261-3632
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2641
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33434500
—
WI
Enumeration date
01/04/2007
Last updated
07/08/2007
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