Provider Demographics
NPI:1083935183
Name:GABA, AMIT
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:GABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2833
Mailing Address - Country:US
Mailing Address - Phone:281-232-6610
Mailing Address - Fax:281-232-8289
Practice Address - Street 1:4114 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2833
Practice Address - Country:US
Practice Address - Phone:281-232-6610
Practice Address - Fax:281-232-8289
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice