Provider Demographics
NPI:1710546189
Name:NOCKOWITZ, GABRIELLE MOON (DMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MOON
Last Name:NOCKOWITZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:NICOLE
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:15 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 21ST AVE
Practice Address - Street 2:
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2384
Practice Address - Country:US
Practice Address - Phone:843-886-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice