Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 4625 | NV |
Y | 1223P0700X | Prosthodontist | 63386 | CA |
NPI | 1063626166 |
---|---|
Provider Name | Quincy L Gibbs |
First Address | Walnut Creek, CA 94596-3895 |
Second Address | Walnut Creek, CA 94596-3895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 06/03/2017 |