Provider Demographics
NPI:1164549044
Name:DOROSTKAR, GILA C (DDS)
Entity Type:Individual
Prefix:
First Name:GILA
Middle Name:C
Last Name:DOROSTKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2024
Mailing Address - Country:US
Mailing Address - Phone:415-461-0414
Mailing Address - Fax:415-461-0431
Practice Address - Street 1:1321 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2024
Practice Address - Country:US
Practice Address - Phone:415-461-0414
Practice Address - Fax:415-461-0431
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry