Provider Demographics
NPI:1861851883
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:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-735-6727
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:843-735-6727
Mailing Address - Fax:
Practice Address - Street 1:749 STOCKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7200
Practice Address - Country:US
Practice Address - Phone:843-735-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1626Medicaid