Healthcare Provider Details

I. General information

NPI: 1780105171
Provider Name (Legal Business Name): DAVID GEMMELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR # D8-18
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

4455 SW 34TH ST APT QQ227
GAINESVILLE FL
32608-6554
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDRP1657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: