Healthcare Provider Details

I. General information

NPI: 1629153069
Provider Name (Legal Business Name): R. SCOTT GAMBLE, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 BATTLES RD
ASHFORD AL
36312
US

IV. Provider business mailing address

PO BOX 408
ASHFORD AL
36312-0408
US

V. Phone/Fax

Practice location:
  • Phone: 334-899-8033
  • Fax: 334-899-8165
Mailing address:
  • Phone: 334-899-8033
  • Fax: 334-899-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4698
License Number StateAL

VIII. Authorized Official

Name: DR. ROBERT S GAMBLE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 334-899-8033