Healthcare Provider Details

I. General information

NPI: 1487458220
Provider Name (Legal Business Name): JOANNA GAMBLE DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 HERITAGE TRADE DR STE 101
WAKE FOREST NC
27587-1001
US

IV. Provider business mailing address

529 LAKE HOLDING ST
WAKE FOREST NC
27587-6856
US

V. Phone/Fax

Practice location:
  • Phone: 919-229-4146
  • Fax: 919-229-4460
Mailing address:
  • Phone: 919-229-4146
  • Fax: 919-229-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOANNA MARIE GAMBLE
Title or Position: OWNER
Credential: DMD
Phone: 919-229-4146