Provider Demographics
NPI:1992297410
Name:GIBBONS, CHAZ MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAZ
Middle Name:MICHAEL
Last Name:GIBBONS
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 1:8700 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3654
Mailing Address - Country:US
Mailing Address - Phone:913-416-6602
Mailing Address - Fax:
Practice Address - Street 1:8700 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3654
Practice Address - Country:US
Practice Address - Phone:913-416-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice