Provider Demographics
NPI:1609252832
Name:GABRIEL A. NOSSA DMDLLC
Entity Type:Organization
Organization Name:GABRIEL A. NOSSA DMDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:NOSSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-332-8133
Mailing Address - Street 1:7328 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1695
Mailing Address - Country:US
Mailing Address - Phone:352-332-8133
Mailing Address - Fax:
Practice Address - Street 1:7328 W UNIVERSITY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1695
Practice Address - Country:US
Practice Address - Phone:352-332-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty