Provider Demographics
NPI:1992764484
Name:GAMBLE, ISOLDA B (DDS)
Entity type:Individual
Prefix:DR
First Name:ISOLDA
Middle Name:B
Last Name:GAMBLE
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 1:2130 W. MLK JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-876-4642
Mailing Address - Fax:813-879-5250
Practice Address - Street 1:5611 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3532
Practice Address - Country:US
Practice Address - Phone:813-866-0930
Practice Address - Fax:813-405-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073956100Medicaid