Active NPI
William Burlin Gibson, D.M.D.
- Oral and Maxillofacial Surgery (Dentist)
- Hazard, KY
National Provider Identifier
1043388234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 7055
- Practice address
- 200 Medical Center Dr
Suite 2-O
Hazard, KY 41701-9466 - Phone
- (606) 487-0088
- Fax
- (606) 487-1849
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 7055 | KY | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 7055 | KY | Primary |
| Dentist | 122300000X | 7055 | KY |
Addresses
Primary practice location
200 Medical Center Dr
Suite 2-O
Hazard, KY 41701-9466
Mailing address
10447 Dryhill Road
Confluence, KY 41749
Phone (606) 672-2075
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60070554 | Medicaid | KY | |
| 238396 | Other | VA | BLUE CROSS BLUE SHIELD VA |
| 000000236923 | Other | KY | BLUE CROSS BLUE SHILED KY |
| 343574 | Other | UNITED CONCORDIA INS | |
| 64342546 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7055 | KY | MD | Oral & Maxillofacial Surgery (D.M.D.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1043388234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10447 DRYHILL ROAD",
"city": "CONFLUENCE",
"state": "KY",
"postal_code": "41749",
"telephone_number": "606-672-2075",
"fax_number": "606-487-1849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MEDICAL CENTER DR",
"address_2": "SUITE 2-O",
"city": "HAZARD",
"state": "KY",
"postal_code": "417019466",
"telephone_number": "606-487-0088",
"fax_number": "606-487-1849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "WILLIAM",
"middle_name": "BURLIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "KY",
"license": "7055",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "KY",
"license": "7055",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "7055",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60070554",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD VA",
"identifier": "238396",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHILED KY",
"identifier": "000000236923",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS",
"identifier": "343574",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64342546",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hazard, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.