Provider Demographics
NPI:1447432455
Name:JASON O GAMBREL P.S.C.
Entity type:Organization
Organization Name:JASON O GAMBREL P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:O
Authorized Official - Last Name:GAMBREL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-626-9851
Mailing Address - Street 1:1018 IVAL JAMES BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-626-9851
Mailing Address - Fax:859-626-9854
Practice Address - Street 1:1018 IVAL JAMES BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-626-9851
Practice Address - Fax:859-626-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty