Diala Gibson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

059955-1 Issued in NY

Practice address

1650 Grand Concourse
Bronx, NY 10457-7606

Phone

(718) 590-1800

NPI assigned

Jun 1, 2017

Last updated

Sep 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1598293789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 GRAND CONCOURSE FL 6",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104538202",
            "telephone_number": "623-523-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577606",
            "telephone_number": "718-590-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "DIALA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-01",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "059955-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Gibilisco
• Karla M Giboyeaux, NUTRITIONIST
• Eileen L Gibson-Green, O.T.R./L
• Andi Gibson
• Delfia Denise Gibson, RN
• Ishmael Gibson
• Laura Gibson, REGISTERED NURSE
• Michael William Gibson, MA, LMHC
• Sasshine Imani Gibson, B.A. ED
• Chantal San Miguel Gicquel, M.D.

• General Practice Dentistry in Bronx, NY
• Providers in Bronx, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; 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.