Organization
GIBSON FAMILY DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BILL J. GIBSON D.D.S. (MANAGING MEMBER)
(304) 965-1200
Entity
Organization
Contact information
Practice address
5089 ELK RIVER ROAD N., ELKVIEW, WV 25071
(304) 965-1200
(304) 965-6158
Mailing address
PO BOX 9, ELKVIEW, WV 25071-0009
(304) 965-1200
(304) 965-6158
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2220
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135148000
—
WV
Enumeration date
09/11/2013
Last updated
02/28/2018
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