Provider Demographics
NPI:1609946219
Name:GIBSON, DANIEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W217 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2031
Mailing Address - Country:US
Mailing Address - Phone:630-653-2672
Mailing Address - Fax:630-653-2756
Practice Address - Street 1:27W217 GENEVA RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2031
Practice Address - Country:US
Practice Address - Phone:630-653-2672
Practice Address - Fax:630-653-2756
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice