Active NPI
Rosalyn Mavis White-Gambrell, D.D.S.
- Dentist
- Meridian, MS
National Provider Identifier
1588715965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 203883
- Practice address
- 1818 College Drive
Meridian, MS 39307-5429 - Phone
- (601) 527-9307
- Fax
- (601) 483-5543
- NPI assigned
- Jan 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 203883 | MS | Primary |
Addresses
Primary practice location
1818 College Drive
Meridian, MS 39307-5429
Mailing address
728 N Hills St
Meridian, MS 39305-1923
Phone (601) 483-2820
Other practice location 1
1818 College Drive
Meridian, MS 39304
Phone (601) 581-7603 ext. 60158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00064018 | Medicaid | MS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | CCP | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 203883 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602720000000",
"number": "1588715965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "728 N HILLS ST",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393051923",
"telephone_number": "601-483-2820",
"fax_number": "601-483-2820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1818 COLLEGE DRIVE",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393075429",
"telephone_number": "601-527-9307",
"fax_number": "601-483-5543"
}
],
"practiceLocations": [
{
"address_1": "1818 College Drive",
"address_purpose": "LOCATION",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "39304",
"country_code": "US",
"telephone_number": "601-581-7603 x60158",
"fax_number": "601-581-7676",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITE-GAMBRELL",
"first_name": "ROSALYN",
"middle_name": "MAVIS",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-14",
"last_updated": "2020-10-15",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "203883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00064018",
"state": "MS"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "CCP",
"affiliation": "N",
"endpointDescription": "Patient Information System",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1818 College Drive",
"city": "MERIDIAN",
"state": "MS",
"country_code": "US",
"postal_code": "39304",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.