Provider Demographics
NPI:1598990947
Name:VANCE, GABRIELLA A (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:A
Last Name:VANCE
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 1:1675 ALHAMBRA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7047
Mailing Address - Country:US
Mailing Address - Phone:916-455-3247
Mailing Address - Fax:916-455-0439
Practice Address - Street 1:1675 ALHAMBRA BLVD STE F
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7047
Practice Address - Country:US
Practice Address - Phone:916-455-3247
Practice Address - Fax:916-455-0439
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist