Provider Demographics
NPI:1851958631
Name:GABRIELLA, MARTI
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:GABRIELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2403
Mailing Address - Country:US
Mailing Address - Phone:781-420-0716
Mailing Address - Fax:
Practice Address - Street 1:575 MOUNT AUBURN ST STE 201
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4627
Practice Address - Country:US
Practice Address - Phone:617-441-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry