Provider Demographics
NPI:1841880739
Name:GAINESVILLE ORAL AND IMPLANT SURGERY, PA
Entity type:Organization
Organization Name:GAINESVILLE ORAL AND IMPLANT SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-331-2016
Mailing Address - Street 1:6801 NW 9TH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4263
Mailing Address - Country:US
Mailing Address - Phone:352-331-2016
Mailing Address - Fax:352-331-1676
Practice Address - Street 1:6801 NW 9TH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4263
Practice Address - Country:US
Practice Address - Phone:352-331-2016
Practice Address - Fax:352-331-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty