Individual
DR. JIMMY R GIBSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1 BROOKDALE PLZ, BROOKLYN, NY 11212-3139
(718) 240-5000
Mailing address
415 SUMMER GLEN CT, STONE MOUNTAIN, GA 30087-5522
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901601226
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/27/2020
Last updated
06/12/2023
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