Provider Demographics
NPI:1194834044
Name:STEPHEN GABRIELSEN DDS PC
Entity Type:Organization
Organization Name:STEPHEN GABRIELSEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GABRIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-998-0551
Mailing Address - Street 1:8160 E BUTHERUS DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2671
Mailing Address - Country:US
Mailing Address - Phone:480-998-0551
Mailing Address - Fax:480-998-0551
Practice Address - Street 1:8160 E BUTHERUS DR
Practice Address - Street 2:SUITE 8
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2671
Practice Address - Country:US
Practice Address - Phone:480-998-0551
Practice Address - Fax:480-998-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental