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General NPI Number Information
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NPI Number | 1669847356
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Entity Type | Individual
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Provider Name | ILAN GAMBURG D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2015
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 421 HIGGINS AVE
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City | BRIELLE
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State | NJ
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Zip | 08730-1413
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Country | US
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Telephone | 732-528-6336
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Fax | 732-528-6424
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Provider Business Mailing Address
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Address Line | 2046 W COUNTY LINE RD
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City | JACKSON
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State | NJ
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Zip | 08527-2034
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Country | US
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Telephone | 732-905-2488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02605000
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License Number State | NJ
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