Provider Demographics
NPI:1962827857
Name:M. TRENT GUBLER, DDS, PC
Entity Type:Organization
Organization Name:M. TRENT GUBLER, DDS, PC
Other - Org Name:LIFETIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:GUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-631-9393
Mailing Address - Street 1:805 N 20TH PL STE 2
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3571
Mailing Address - Country:US
Mailing Address - Phone:479-631-9393
Mailing Address - Fax:479-986-0905
Practice Address - Street 1:805 N 20TH PL STE 2
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3571
Practice Address - Country:US
Practice Address - Phone:479-631-9393
Practice Address - Fax:479-986-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty