Gibson, Rex Shannon
Gibson, Rex Shannon is an sole proprietor health care provider with primary practice located at 1245 Se 3Rd St Ste #A-1, Bend OR 97702-2161. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Gibson, Rex Shannon can be contacted via phone (541) 318-5688.Contact Information
Primary practice address
1245 Se 3Rd St Ste #A-1
Bend OR 97702-2161
Phone: (541) 318-5688
Fax: (541) 322-5581
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | D7724 | Oregon |
Profile Details
| NPI number | 1174730287 |
|---|---|
| LBN Legal business name | Gibson, Rex Shannon |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 17th, 2007 |
| Last updated | Jan 15th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174730287 | NPPES |
| Oregon | MEDICAID | 299183 |
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