Provider Demographics
NPI:1225771363
Name:WAINWRIGHT, GABRIELLE
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3350
Mailing Address - Country:US
Mailing Address - Phone:650-740-9671
Mailing Address - Fax:
Practice Address - Street 1:970 W EL CAMINO REAL STE 1
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1180
Practice Address - Country:US
Practice Address - Phone:650-282-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1050481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics