Dr. Rafael Gamboa

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

913 Issued in NV

Legal business name

DR. RAFAEL GAMBOA

Practice address

1601 Lakeside Dr
Reno, NV 89509-3408

Phone

(775) 322-8610

Fax

(775) 322-7698

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Rafael M Gamboa, DDS

Title

President

Phone

(775) 322-8610

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649378324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895093408",
            "telephone_number": "775-322-8610",
            "fax_number": "775-322-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895093408",
            "telephone_number": "775-322-8610",
            "fax_number": "775-322-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. RAFAEL GAMBOA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAMBOA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "775-322-8610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Reno, NV
• Providers in Reno, NV by specialty
• Periodontics in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.