NPIMap

Organization Active NPI

Gibson Dental LLC

  • General Practice Dentistry
  • Madison, AL
National Provider Identifier
1073963625
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6093 Issued in AL
Legal business name
GIBSON DENTAL LLC
Practice address
10871 County Line Rd
Suite a
Madison, AL 35758-3667
Phone
(256) 724-3530
Fax
(256) 615-8740
NPI assigned
Jun 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matt Gibson
Title
Dentist
Phone
(256) 724-3530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 6093 AL Primary

Addresses

Primary practice location

10871 County Line Rd
Suite a
Madison, AL 35758-3667

Mailing address

10871 County Line Rd
Suite a
Madison, AL 35758-3667
Phone (256) 724-3530

Other names 1

  • Gibson Dental Doing business as

National Provider Directory

National Provider Directory

Locations

10871 County Line Rd
Ste A
Madison, AL 35758
Phone (256) 724-3530

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1073963625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10871 COUNTY LINE RD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357583667",
            "telephone_number": "256-724-3530",
            "fax_number": "256-615-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10871 COUNTY LINE RD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357583667",
            "telephone_number": "256-724-3530",
            "fax_number": "256-615-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "256-724-3530",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "6093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gibson Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.