Healthcare Provider Details

I. General information

NPI: 1033244165
Provider Name (Legal Business Name): WILLIAM ELLSWORTH GABLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S KENNEBEC AVE
MCCONNELSVILLE OH
43756
US

IV. Provider business mailing address

137 S KENNEBEC AVE
MCCONNELSVILLE OH
43756
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-5727
  • Fax: 740-962-6393
Mailing address:
  • Phone: 740-962-5727
  • Fax: 740-962-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17979
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: