Provider Demographics
NPI:1326249129
Name:GABRIELLI, MARIO (DDS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:GABRIELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HILLSIDE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2513
Mailing Address - Country:US
Mailing Address - Phone:516-488-6688
Mailing Address - Fax:516-488-6699
Practice Address - Street 1:700 HILLSIDE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2513
Practice Address - Country:US
Practice Address - Phone:516-488-6688
Practice Address - Fax:516-488-6699
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice