Provider Demographics
NPI:1124146410
Name:GAMBILL, JOHN ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:GAMBILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N OAK
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1444
Mailing Address - Country:US
Mailing Address - Phone:573-392-3400
Mailing Address - Fax:573-392-6490
Practice Address - Street 1:111 N OAK
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1444
Practice Address - Country:US
Practice Address - Phone:573-392-3400
Practice Address - Fax:573-392-6490
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist