Rex Shannon Gibson, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D7724 Issued in OR

Practice address

1245 SE 3Rd St
Ste #a-1
Bend, OR 97702-2161

Phone

(541) 318-5688

Fax

(541) 322-5581

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200355200000",
    "number": "1174730287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63870 JOHNSON RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977015218",
            "telephone_number": "541-318-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 SE 3RD ST",
            "address_2": "STE #A-1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022161",
            "telephone_number": "541-318-5688",
            "fax_number": "541-322-5581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "REX",
        "middle_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D7724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299183",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adiam T Ghirmatsion, PHARMD
• Kevin Giannini, PT, DPT
• Sofia Alejandra Gibson-Godoy
• Allen Gibson
• Joslyn Gibson, PA-C
• Christine Howard Gieben, PSY.D
• Alexandria Gientke, AGNP
• Patricia Ann Giffin, PH.D.
• Darcy Gilbert Bridwell, M.A.
• Elaine Margaret Gilbert, RN

• Pediatric Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.