Provider Demographics
NPI:1558471086
Name:MAR, GISELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:MAR
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 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:2380 LAS POSAS RD
Practice Address - Street 2:A & D
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3456
Practice Address - Country:US
Practice Address - Phone:805-388-9110
Practice Address - Fax:805-987-5140
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice