Provider Demographics
NPI:1235771395
Name:PALACIOS, GABRIELA A (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:A
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:A
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10177 W GRAND PKWY S
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10177 W GRAND PKWY S STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8682
Practice Address - Country:US
Practice Address - Phone:346-702-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR032R122300000X
TX379451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist