MEDICARE: DR. PAUL GAMMAL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	063264	NY

General Provider Information

NPI Number	:	1891251807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL GAMMAL DDS

Provider Business Mailing Address
First Line	:	460 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4137
Country	:	US
Telephone Number	:	917-974-0869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	06/06/2025

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