Provider Demographics
NPI:1184823122
Name:IONESCU, GABRIEL BOGDAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:BOGDAN
Last Name:IONESCU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-11 QUEENS BLVD
Mailing Address - Street 2:MAIN FLOOR
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:718-784-0110
Mailing Address - Fax:718-784-0110
Practice Address - Street 1:41-11 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-784-0110
Practice Address - Fax:718-784-0110
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01274455Medicaid
NY043705OtherNYU