Individual
TANYA MARIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
650 E 25TH ST, KANSAS CITY, MO 64108-2716
(816) 235-2133
(816) 235-5473
Mailing address
650 E 25TH ST FL 3, KANSAS CITY, MO 64108-2716
(816) 235-2133
(816) 235-5473
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
26D0652227
MO
291U00000X
Clinical Medical Laboratory
44D2016339
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012015348
MO DEPT OF COMMERCE AND INS DIVISION OF PROFESSION REGISTRATION MO DENTAL BOARD
MO
01
—
8615
MEDICAL LICENSE
TX
Enumeration date
01/10/2011
Last updated
04/15/2026
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