Provider Demographics
NPI:1073769576
Name:GABLE, MICHAEL W (DDS,)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:GABLE
Suffix:
Gender:M
Credentials:DDS,
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:WILLIAM
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3001
Mailing Address - Country:US
Mailing Address - Phone:858-549-9688
Mailing Address - Fax:858-549-7103
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:SUITE 138
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3001
Practice Address - Country:US
Practice Address - Phone:858-549-9688
Practice Address - Fax:858-549-7103
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist