Individual
NICOLE LEE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
1406 N AZUSA AVE, UNIT #C, COVINA, CA 91722-1257
(626) 858-9940
(626) 858-9366
Mailing address
1537 W SAN BERNARDINO RD, APT. #C, WEST COVINA, CA 91790-1016
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
23400
CA
Other
Enumeration date
06/17/2011
Last updated
06/17/2011
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