Micahel Jason Gambill, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

6422 Issued in LA

Practice address

2285 Benton Rd Ste C100
Bossier City, LA 71111-3465

Phone

(318) 742-9333

Fax

(318) 747-9089

NPI assigned

May 17, 2013

Last updated

Nov 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Michael Gambill and Dr. David Glass LLC

  dba Pediatric Dentistry of Shreveport-Bossier

  • Pediatric Dentistry
  • Bossier City, LA
  • NPI 1851779623
  NPD (past)
• DRS Michael Gambill and Corey Cloud LLC

  dba Pediatric Dentistry of Cenla

  • Pediatric Dentistry
  • Bossier City, LA
  • NPI 1750159737
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542326400000",
    "number": "1023454071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD STE C100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113465",
            "telephone_number": "318-742-9333",
            "fax_number": "318-747-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD STE C100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113465",
            "telephone_number": "318-742-9333",
            "fax_number": "318-747-9089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBILL",
        "first_name": "MICAHEL",
        "middle_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-17",
        "last_updated": "2018-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "00201959",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30872",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josephine Futrell, M.D.
• Jane Tsung-Wen Wong Futterer, MD
• G. Keith Christy, M.D., Apmc
• Ladonia Gage
• Nevada Marie Gaines
• Cecilia Guevara Garceau, CAC, CCS
• Mariam Garcia, FNP
• Ricardo Garcia
• Garden Court Healthcare LLC (Garden Court Health and Rehabilitation Center)
• Chanell Gardner

• Pediatric Dentistry in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.