Healthcare Provider Details

I. General information

NPI: 1881159440
Provider Name (Legal Business Name): GABRIEL A. CHAMBLIN DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 US HIGHWAY 90 STE D
SPANISH FORT AL
36527-9480
US

IV. Provider business mailing address

6450 US HIGHWAY 90 STE D
SPANISH FORT AL
36527-9480
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-7675
  • Fax: 251-626-8194
Mailing address:
  • Phone: 251-626-7675
  • Fax: 251-626-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIEL ALPHONSE CHAMBLIN V
Title or Position: OWNER
Credential: DMD
Phone: 251-626-7675