MEDICARE: VIRDISLAND C GAMBLE DDS PA

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	1223G0001X	General Practice Dentistry	22934	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821343591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRDISLAND C GAMBLE DDS PA

Provider Business Mailing Address
First Line	:	7120 FM 1464 RD
Second Line	:	SUITE B
City	:	RICHMOND
State	:	TX
Zip	:	77407-6400
Country	:	US
Telephone Number	:	713-340-1300
Fax Number	:	281-271-8617

Provider Business Practice Location Address
First Line	:	7120 FM 1464 RD
Second Line	:	SUITE B
City	:	RICHMOND
State	:	TX
Zip	:	77407-6400
Country	:	US
Telephone Number	:	713-340-1300
Fax Number	:	281-271-8617

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIRDISLAND C GAMBLE
Credential	:	DDS
Telephone Number	:	713-340-1300

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	03/07/2023

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