Provider Demographics
NPI:1922171768
Name:GAMBLE, WILLIAM H (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:H
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:570 THOMSON HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30828-9007
Mailing Address - Country:US
Mailing Address - Phone:706-465-3386
Mailing Address - Fax:706-465-0608
Practice Address - Street 1:570 THOMSON HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-9007
Practice Address - Country:US
Practice Address - Phone:706-465-3386
Practice Address - Fax:706-465-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00045889EMedicaid