Healthcare Provider Details

I. General information

NPI: 1821155086
Provider Name (Legal Business Name): DEAN R GAMBINO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N GREENFIELD RD # 101
GILBERT AZ
85234-5012
US

IV. Provider business mailing address

726 N GREENFIELD RD # 101
GILBERT AZ
85234-5012
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-8620
  • Fax:
Mailing address:
  • Phone: 480-833-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD18538
License Number StateAZ

VIII. Authorized Official

Name: DEAN RUSS GAMBINO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-833-8620