Provider Demographics
NPI:1366606428
Name:GIBBS, THOMAS R (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5712
Mailing Address - Country:US
Mailing Address - Phone:630-858-8800
Mailing Address - Fax:630-858-3067
Practice Address - Street 1:26 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5712
Practice Address - Country:US
Practice Address - Phone:630-858-8800
Practice Address - Fax:630-858-3067
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19177141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice