Provider Demographics
NPI:1578509139
Name:GIBSON, JOHN ACE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ACE
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:WILLIAM
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1062 EAST LANCASTER AVE.
Mailing Address - Street 2:APT. 510-11
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1524
Mailing Address - Country:US
Mailing Address - Phone:610-348-5747
Mailing Address - Fax:610-667-4373
Practice Address - Street 1:1062 EAST LANCASTER AVE.
Practice Address - Street 2:APT. 510-11
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1524
Practice Address - Country:US
Practice Address - Phone:610-348-5747
Practice Address - Fax:610-667-4373
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344601223G0001X
PADS022006L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice