Provider Demographics
NPI:1760889984
Name:GAMBLE DENTALSMART PC
Entity Type:Organization
Organization Name:GAMBLE DENTALSMART PC
Other - Org Name:DENTALSMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-614-6769
Mailing Address - Street 1:2020 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6286
Mailing Address - Country:US
Mailing Address - Phone:843-614-6769
Mailing Address - Fax:
Practice Address - Street 1:1739 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2103
Practice Address - Country:US
Practice Address - Phone:843-614-6846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX1626Medicaid