Provider Demographics
NPI:1528515129
Name:ANDREA PINNICK GAMBLE DDS, INC
Entity type:Organization
Organization Name:ANDREA PINNICK GAMBLE DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:PINNICK
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-373-0007
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:90277-5715
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:90277-5715
Practice Address - Country:US
Practice Address - Phone:310-373-0007
Practice Address - Fax:310-373-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty