Provider Demographics
NPI:1124505888
Name:GIBBS, KIMBERLY MICHELLE PARESA (DMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE PARESA
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W GOODALE ST APT 567
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1910
Mailing Address - Country:US
Mailing Address - Phone:503-348-5765
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR STE 5A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2639
Practice Address - Country:US
Practice Address - Phone:614-722-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.004457122300000X
ORD108551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist