MEDICARE: CHAD N GUBLER, DDS CASINO DIRECT, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1679397806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD N GUBLER, DDS CASINO DIRECT, LTD

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD STE 500
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2309
Country	:	US
Telephone Number	:	702-322-2200
Fax Number	:	702-330-5781

Provider Business Practice Location Address
First Line	:	2430 E HARMON AVE STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5338
Country	:	US
Telephone Number	:	702-796-0095
Fax Number	:	702-761-4551

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. CHAD N GUBLER
Credential	:	DDS
Telephone Number	:	702-349-6350

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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