Harry E Gibson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2641 Issued in MN

Practice address

1149 Boughton St BLDG B
Watertown, WI 53094-3104

Phone

(920) 261-0495

Fax

(920) 261-3632

NPI assigned

Jan 4, 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

Enrolled in WI

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)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467509430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 BOUGHTON ST BLDG B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943104",
            "telephone_number": "920-261-0495",
            "fax_number": "920-261-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 BOUGHTON ST BLDG B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943104",
            "telephone_number": "920-261-0495",
            "fax_number": "920-261-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "HARRY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "2641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33434500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Fruendt, D.C.
• Jennifer Wynne Furlong, APNP
• Jennifer Garcia, OTR/L
• Mary K Gatzke, DNP
• Jade Gauthier, PTA
• Lynn Marie Gilbert, RN/RCS
• Nadine May Gilbert, LCSW
• Cary J Gillingham, D.D.S.
• Sherry Gnabasik, 2120-19
• Leslie M. Golden, MD

• General Practice Dentistry in Watertown, WI
• Providers in Watertown, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.