Provider Demographics
NPI:1891779476
Name:GUGALE, MONIKA S (DDS)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:S
Last Name:GUGALE
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 1:1390 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8260
Mailing Address - Country:US
Mailing Address - Phone:909-248-4253
Mailing Address - Fax:
Practice Address - Street 1:615 OLIVE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:CA
Practice Address - Zip Code:95692-9787
Practice Address - Country:US
Practice Address - Phone:530-633-2865
Practice Address - Fax:530-633-9491
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG7757579OtherDEA