Provider Demographics
NPI:1447452735
Name:GAMBLE, ANDREA PINNICK (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:PINNICK
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:CHRISTINE
Other - Last Name:PINNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1706 S. ELENA AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-373-0007
Mailing Address - Fax:310-373-0014
Practice Address - Street 1:1706 S. ELENA AVE
Practice Address - Street 2:STE. C
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-373-0007
Practice Address - Fax:310-373-0014
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2421223G0001X
CA579851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice