Individual
DR. MICAHEL JASON GAMBILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2285 BENTON RD STE C100, BOSSIER CITY, LA 71111-3465
(318) 742-9333
(318) 747-9089
Mailing address
2285 BENTON RD STE C100, BOSSIER CITY, LA 71111-3465
(318) 742-9333
(318) 747-9089
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
00201959
CO
1223P0221X
Pediatric Dentistry
Primary
6422
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30872
—
LA
Enumeration date
05/17/2013
Last updated
11/16/2018
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