Provider Demographics
NPI:1437936465
Name:SHAKER, GINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:SHAKER
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 1:4170 ADMIRALTY WAY UNIT 325
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6219
Mailing Address - Country:US
Mailing Address - Phone:949-742-2747
Mailing Address - Fax:
Practice Address - Street 1:4170 ADMIRALTY WAY UNIT 325
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6219
Practice Address - Country:US
Practice Address - Phone:949-742-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist