Joel D Gibson, DMD PA
Individual provider Active NPI General Practice Dentistry · Rosedale, MS
NPI 1215068630 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215068630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 207684 (MS)
- Practice address
- 512 Levee St
Rosedale, MS 38769 - Phone
- (662) 759-6603
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 207684 | MS | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 207684 | MS | Yes |
Addresses
Primary practice location
512 Levee St
Rosedale, MS 38769
Mailing address
PO Box 820
Rosetale, MS 38769
Phone (662) 759-6603
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00060080 | Medicaid | MS |
Other providers in Rosedale, MS
- Angel of Mercy Hospice
- Valerie Orcutt Antici
- Bolivar Physician Practices LLC
- Delta Health Center, Inc
- Essential School Based Health Clinic
- Joy'S Loving Care Adult Daycare Center
- John William Lewis Jr.
- Karminee Love
- Mississippi State Department of Health
- Rosedale Family Medical Center, P.C.
All providers in Rosedale, MS · General Practice Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.