Gabriel J Chamorro, DDS
Individual provider Active NPI Dentist · Lake Wales, FL
NPI 1922447846 · NPPES record last updated Aug 10, 2015
Key facts
- NPI
- 1922447846
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 21527 (FL)
- Practice address
- 24185 US Highway 27
Lake Wales, FL 33859-7819 - Phone
- (863) 455-7444
- NPI assigned
- Jun 25, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21527 | FL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 21527 | FL | Yes |
Addresses
Primary practice location
24185 US Highway 27
Lake Wales, FL 33859-7819
Mailing address
24185 US Highway 27
Lake Wales, FL 33859-7819
Phone (863) 455-7444
Other providers in Lake Wales, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.