Active NPI
Kevin Gibbs, DMD
- Dentist
- North Pekin, IL
National Provider Identifier
1477923712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019021806
- Practice address
- 137 Radio City Dr
Ste C
North Pekin, IL 61554-1569 - Phone
- (773) 407-8304
- NPI assigned
- Sep 29, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019021806 | IL | Primary |
Addresses
Primary practice location
137 Radio City Dr
Ste C
North Pekin, IL 61554-1569
Mailing address
PO Box 268111
Chicago, IL 60626-8111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019021806 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443484800000",
"number": "1477923712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 268111",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606268111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 RADIO CITY DR",
"address_2": "STE C",
"city": "NORTH PEKIN",
"state": "IL",
"postal_code": "615541569",
"telephone_number": "773-407-8304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBS",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-29",
"last_updated": "2015-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019021806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Pekin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.