Provider Demographics
NPI:1235806126
Name:BURGESS, GAIL MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:MARIE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3117 G ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3224
Mailing Address - Country:US
Mailing Address - Phone:256-665-0459
Mailing Address - Fax:
Practice Address - Street 1:435 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6234
Practice Address - Country:US
Practice Address - Phone:619-850-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1068991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice