Provider Demographics
NPI:1417696410
Name:PUNG, GABRIELLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:
Last Name:PUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 ATLANTA AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6162
Mailing Address - Country:US
Mailing Address - Phone:920-379-5289
Mailing Address - Fax:
Practice Address - Street 1:7540 ORANGETHORPE AVE STE A1
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3458
Practice Address - Country:US
Practice Address - Phone:714-576-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice