Phattara Gibbs, DMD Valid NPI

Individual provider · Dentist · Lakeland, FL

NPI

1205094117

Type

Individual (Type 1)

Primary specialty

Dentist

Specialty group

Dental Providers

Taxonomy code

122300000X

License number

DN18269 (FL)

Sex

Male

Sole proprietor

Yes

Enumerated

2008-05-28

Last updated

2009-11-03