Individual
DR. MARCUS A GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
(502) 772-8189
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 953-4700
(502) 772-8189
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7305
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100174040
—
KY
Enumeration date
03/12/2007
Last updated
04/14/2021
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