Individual
DR. GIBSON GREGG HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1059 EDEN WAY N STE 100, CHESAPEAKE, VA 23320-2789
(757) 547-2266
Mailing address
1059 EDEN WAY N STE 100, CHESAPEAKE, VA 23320-2789
(757) 547-2266
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410402
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10402
DELTA
VA
01
—
1311708
UNITED CONCORDIA
—
01
—
236011
ANTHEM, BC & BS OF VA
VA
Enumeration date
02/26/2007
Last updated
07/08/2007
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