Gibson O, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DD4194 Issued in NM

Practice address

2150 Highway 54 S
Alamogordo, NM 88310-7330

Phone

(575) 443-8133

Fax

(575) 443-8055

NPI assigned

Jul 21, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Las Cruces, NM
  • NPI 1699105320
  NPD (past)
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Radium Springs, NM
  • NPI 1770734865
  NPD (past)
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Alamogordo, NM
  • NPI 1902831977
  NPD (past)

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1154586170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 HIGHWAY 54 S",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883107330",
            "telephone_number": "575-443-8133",
            "fax_number": "575-443-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O",
        "first_name": "GIBSON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "0024099",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "053883",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxwell Nkrumah-Abrokwah, PHARMD
• Kayla Novoa, PA
• Scott Nufer, DPT
• Oliver C Nuique, DPT
• Heather Nye
• Jaleesa O'Banner
• Oasis Family Health Center LLC
• Oluwabunmi Sarah Oba, NP
• Holly Obrovac, RN
• Andrea Ocasio, CNP

• Dentist in Alamogordo, NM
• Providers in Alamogordo, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.