Provider Demographics
NPI:1689384943
Name:GOUBRAIL, HADIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HADIL
Middle Name:
Last Name:GOUBRAIL
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 1:12163 SAINT TROPEZ DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2766
Mailing Address - Country:US
Mailing Address - Phone:310-658-6695
Mailing Address - Fax:
Practice Address - Street 1:12163 SAINT TROPEZ DR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2766
Practice Address - Country:US
Practice Address - Phone:310-658-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist