Provider Demographics
NPI:1346236270
Name:HOSTALET, GABRIEL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:D
Last Name:HOSTALET
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 1:6695 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8923
Mailing Address - Country:US
Mailing Address - Phone:317-272-2200
Mailing Address - Fax:317-272-4226
Practice Address - Street 1:6695 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8923
Practice Address - Country:US
Practice Address - Phone:317-272-2200
Practice Address - Fax:317-272-4226
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120104481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000373334OtherANTHEM
IN000000373334OtherANTHEM
INV06305Medicare UPIN