Provider Demographics
NPI:1366572406
Name:GIBSON, JOE E JR (DDS, M,S,)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:E
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:DDS, M,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WEST MORRIS BLVD
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-0338
Mailing Address - Country:US
Mailing Address - Phone:423-581-4545
Mailing Address - Fax:423-587-4104
Practice Address - Street 1:139 WEST MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37816-0338
Practice Address - Country:US
Practice Address - Phone:423-581-4545
Practice Address - Fax:423-587-4104
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS45301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics