Provider Demographics
NPI:1487675880
Name:GIBBONS, THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GIBBONS
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 1:6500 GREENVILLE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1014
Mailing Address - Country:US
Mailing Address - Phone:214-696-8096
Mailing Address - Fax:214-696-8095
Practice Address - Street 1:6500 GREENVILLE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1014
Practice Address - Country:US
Practice Address - Phone:214-696-8096
Practice Address - Fax:214-696-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice