Provider Demographics
NPI:1679698690
Name:GABALDON, GENE ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:ALAN
Last Name:GABALDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 S LOCUST
Mailing Address - Street 2:STE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:505-521-0306
Mailing Address - Fax:505-522-1132
Practice Address - Street 1:2460 S LOCUST
Practice Address - Street 2:STE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:505-521-0306
Practice Address - Fax:505-522-1132
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 17041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00083655Medicaid
NM283655Medicaid
NM3248Medicaid