Individual
DR. JASON OTTO GAMBREL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1018 IVAL JAMES BLVD, SUITE C, RICHMOND, KY 40475-8026
(859) 626-9851
(859) 626-9854
Mailing address
1018 IVAL JAMES BLVD, SUITE C, RICHMOND, KY 40475-8026
(859) 626-9851
(859) 626-9854
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7992
KY
1223G0001X
General Practice Dentistry
7992
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45004025
—
KY
05
—
60004066
—
KY
Enumeration date
01/13/2006
Last updated
06/10/2008
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