Provider Demographics
NPI:1467707711
Name:GABA DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:GABA DENTAL CLINIC LLC
Other - Org Name:PERFECT DENTAL OF ROSENBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-6610
Mailing Address - Street 1:4114 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2833
Mailing Address - Country:US
Mailing Address - Phone:281-232-6610
Mailing Address - Fax:
Practice Address - Street 1:4114 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2833
Practice Address - Country:US
Practice Address - Phone:281-232-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2143208Medicaid