Provider Demographics
NPI:1225523269
Name:COLON, GABRIELLE ST GERMAIN (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ST GERMAIN
Last Name:COLON
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 1:812 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4949
Mailing Address - Country:US
Mailing Address - Phone:985-626-9791
Mailing Address - Fax:985-727-9791
Practice Address - Street 1:812 PARK AVE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4949
Practice Address - Country:US
Practice Address - Phone:985-626-9791
Practice Address - Fax:985-727-9791
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2023-10-03
Deactivation Date:2023-06-20
Deactivation Code:
Reactivation Date:2023-09-22
Provider Licenses
StateLicense IDTaxonomies
MO20180191281223G0001X
LA68451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice