Paul Robert Gibbs, DDS MS PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6435 Issued in NC

Practice address

460 S Main St
Building 300 Suite 301
Davidson, NC 28036

Phone

(704) 892-0644

Fax

(704) 892-6617

NPI assigned

May 13, 2008

Sex

Male

Sole proprietor

No

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 NC

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

Credentials

Master of Science, Physician Assistant

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1942477609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2241",
            "address_2": "460 S MAIN ST BUILDING 300 SUITE 301",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "28036",
            "telephone_number": "704-892-0644",
            "fax_number": "704-892-6617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 S MAIN ST",
            "address_2": "BUILDING 300 SUITE 301",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "28036",
            "telephone_number": "704-892-0644",
            "fax_number": "704-892-6617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBS",
        "first_name": "PAUL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS MS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "6435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Davidson, NC
• Providers in Davidson, NC by specialty
• Periodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.