Provider Demographics
NPI:1649680042
Name:KIRKWOOD GAMBLE, CAROL (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:KIRKWOOD GAMBLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11369 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2610
Mailing Address - Country:US
Mailing Address - Phone:813-818-0600
Mailing Address - Fax:813-818-8405
Practice Address - Street 1:11369 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2610
Practice Address - Country:US
Practice Address - Phone:813-818-0600
Practice Address - Fax:813-818-8405
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL014190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist