Provider Demographics
NPI:1992316129
Name:GAMBILL, JORDANNE (DDS)
Entity type:Individual
Prefix:
First Name:JORDANNE
Middle Name:
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1256
Mailing Address - Country:US
Mailing Address - Phone:937-728-2231
Mailing Address - Fax:
Practice Address - Street 1:7218 US 31 S
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8539
Practice Address - Country:US
Practice Address - Phone:317-882-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120123456B122300000X
IN12013456A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist