Provider Demographics
NPI:1710189030
Name:CHIBAMBO SMITH, GADI MUHLABASE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GADI
Middle Name:MUHLABASE
Last Name:CHIBAMBO SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROLLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3031
Mailing Address - Country:US
Mailing Address - Phone:845-986-4352
Mailing Address - Fax:
Practice Address - Street 1:9 ROLLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3031
Practice Address - Country:US
Practice Address - Phone:845-986-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043769-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist