Healthcare Provider Details

I. General information

NPI: 1548084759
Provider Name (Legal Business Name): CHAD N GUBLER DDS CASINO DIRECT LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 MONTESSOURI ST STE 109
LAS VEGAS NV
89117-3063
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 500
LAS VEGAS NV
89102-2309
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-9353
  • Fax: 702-761-4545
Mailing address:
  • Phone: 702-322-2200
  • Fax: 702-330-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD N GUBLER
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 702-349-6350