Individual
DR. SUSAN BALLOU GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MSD
Contact information
Practice address
110 HARDIN LN, SUITE 2, SOMERSET, KY 42503-3818
(606) 678-9664
(606) 679-1457
Mailing address
110 HARDIN LN, SUITE 2, SOMERSET, KY 42503-3818
(606) 678-9664
(606) 679-1457
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6224
KY
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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