NPIMap

Organization Active NPI

Dr. Michael Gambill and Dr. David Glass LLC

Doing business as Pediatric Dentistry of Shreveport-Bossier

  • Pediatric Dentistry
  • Bossier City, LA
National Provider Identifier
1851779623
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6422 Issued in LA
Legal business name
DR. MICHAEL GAMBILL AND DR. DAVID GLASS LLC
Doing business as
Pediatric Dentistry of Shreveport-Bossier
Practice address
2285 Benton Rd
Suite C-100
Bossier City, LA 71111-7933
Phone
(318) 742-9333
Fax
(318) 742-1512
NPI assigned
May 13, 2015
Last updated
May 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Authorized official

Name
Carol A Lloyd
Title
Office Manager
Phone
(318) 742-9333

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 2217 LA
Pediatric Dentistry 1223P0221X 6485 LA
Pediatric Dentistry 1223P0221X 6224 LA
Pediatric Dentistry 1223P0221X 6532 LA
Pediatric Dentistry 1223P0221X 6422 LA Primary

Addresses

Primary practice location

2285 Benton Rd
Suite C-100
Bossier City, LA 71111-7933

Mailing address

2285 Benton Rd
Suite C-100
Bossier City, LA 71111-7933
Phone (318) 742-9333

Other identifiers 3

IdentifierTypeStateIssuer
1864226MedicaidLA
1822175MedicaidLA
1864854MedicaidLA

Other names 1

  • Pediatric Dentistry of Shreveport-Bossier Doing business as

National Provider Directory

National Provider Directory

Locations

2285 Benton Rd
Ste C100
Bossier City, LA 71111
Phone (318) 742-9333

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1851779623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD",
            "address_2": "SUITE C-100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117933",
            "telephone_number": "318-742-9333",
            "fax_number": "318-742-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD",
            "address_2": "SUITE C-100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117933",
            "telephone_number": "318-742-9333",
            "fax_number": "318-742-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MICHAEL GAMBILL AND DR. DAVID GLASS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "LLOYD",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-742-9333"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "2217",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6485",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6224",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6532",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1864226",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1822175",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1864854",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Shreveport-Bossier",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; 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.