Provider Demographics
NPI:1568579282
Name:WILLIAMS, GABRIELLE VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:VICTORIA
Last Name:WILLIAMS
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 1:8823 UNIVERSITY EAST DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5147
Mailing Address - Country:US
Mailing Address - Phone:704-569-8949
Mailing Address - Fax:704-596-8185
Practice Address - Street 1:8823 UNIVERSITY EAST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4207
Practice Address - Country:US
Practice Address - Phone:704-569-8949
Practice Address - Fax:704-596-8185
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
9022UOtherBLUE CROSS BLUE SHIELD NC
NC5902242Medicaid