Provider Demographics
NPI:1821786997
Name:GABASHVILI, EKATERINA (DMD)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:GABASHVILI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BROADWAY APT 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2359
Mailing Address - Country:US
Mailing Address - Phone:323-215-8426
Mailing Address - Fax:
Practice Address - Street 1:821 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3821
Practice Address - Country:US
Practice Address - Phone:310-604-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist