Individual
DR. WANDA D GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8063 EDMUND HWY, EAU CLAIRE COOPERATIVE HEALTH CENTERS, PELION, SC 29123-9805
(803) 894-3736
(803) 894-5315
Mailing address
169 LAURELHURST AVE, COLUMBIA, SC 29210-3825
(803) 733-5969
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC7106
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LNO7106
DENTAL REGISTRATION
SC
05
—
ZX7106
—
SC
Enumeration date
10/19/2006
Last updated
03/07/2023
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