Provider Demographics
NPI:1922447846
Name:CHAMORRO, GABRIEL J (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:J
Last Name:CHAMORRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24185 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7819
Mailing Address - Country:US
Mailing Address - Phone:863-455-7444
Mailing Address - Fax:
Practice Address - Street 1:24185 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7819
Practice Address - Country:US
Practice Address - Phone:863-455-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist