Provider Demographics
NPI:1417316175
Name:CHAD GUBLER CASINO DIRECT-ORTHO
Entity type:Organization
Organization Name:CHAD GUBLER CASINO DIRECT-ORTHO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:GUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-349-6350
Mailing Address - Street 1:1701 W. CHARLESTON BLVD. STE 500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2309
Mailing Address - Country:US
Mailing Address - Phone:702-322-2200
Mailing Address - Fax:702-330-5781
Practice Address - Street 1:3481 E. SUNSET RD. STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-322-2180
Practice Address - Fax:702-761-4359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAD N.GUBLER DDS, CASINO DIRECT, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-23
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760863286Medicaid