MEDICARE: GAMBLE DENTALSMART PC

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

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	:	1861851883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAMBLE DENTALSMART PC

Provider Business Mailing Address
First Line	:	2020 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6286
Country	:	US
Telephone Number	:	843-735-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	749 STOCKBRIDGE DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7200
Country	:	US
Telephone Number	:	843-735-6727
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	ROBERT GAMBLE JR.
Credential	:
Telephone Number	:	843-735-6727

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	04/04/2016

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