Provider Demographics
NPI:1316304827
Name:GIBSON, RYAN B (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:B
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 BUFFALO GAP RD STE C
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1264
Mailing Address - Country:US
Mailing Address - Phone:326-959-9704
Mailing Address - Fax:432-695-9974
Practice Address - Street 1:5849 BUFFALO GAP RD STE C
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1264
Practice Address - Country:US
Practice Address - Phone:325-704-5001
Practice Address - Fax:325-704-5141
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics