| Organization Name: | DR. BRUCE P GIBBS, INC |
| NPI Number: | 1073970612 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE P GIBBS (OWNER) |
| Mailing Address: | 16620 State Route 267 East Liverpool |
| State: | OH US |
| Postal Code: | 439203938 |
| Phone Number: | 3303851198 |
| Fax Number: | 3303857230 |
| NPI Enumeration Date: | 01/27/2016 |
| NPI Last Update Date: | 01/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 15822 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |