Provider Demographics
NPI:1427375591
Name:GAMBRILLS ORTHODONTICS
Entity Type:Organization
Organization Name:GAMBRILLS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKOUAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-347-1282
Mailing Address - Street 1:331 GAMBRILLS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1141
Mailing Address - Country:US
Mailing Address - Phone:410-923-4700
Mailing Address - Fax:410-923-7600
Practice Address - Street 1:331 GAMBRILLS RD STE 7
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1141
Practice Address - Country:US
Practice Address - Phone:410-923-4700
Practice Address - Fax:410-923-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty