Provider Demographics
NPI:1114524493
Name:GIBULA, JAMIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:GIBULA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:PERUGINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8907 S HOWELL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4460
Mailing Address - Country:US
Mailing Address - Phone:414-304-5425
Mailing Address - Fax:414-301-9465
Practice Address - Street 1:8907 S HOWELL AVE STE 400
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4460
Practice Address - Country:US
Practice Address - Phone:414-304-5425
Practice Address - Fax:414-301-9465
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100-2486-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice