Provider Demographics
NPI:1023243326
Name:GIBBS, MERIDITH MADDOX (DMD)
Entity type:Individual
Prefix:DR
First Name:MERIDITH
Middle Name:MADDOX
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 1:139 ALPINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8834
Mailing Address - Country:US
Mailing Address - Phone:859-948-6369
Mailing Address - Fax:
Practice Address - Street 1:205 WAYNESVILLE PLZ
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-5765
Practice Address - Country:US
Practice Address - Phone:859-948-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY87421223G0001X
NC9030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice