Provider Demographics
NPI:1912552803
Name:YOON, GABRIELLE ANNE (DH)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:ANNE
Last Name:YOON
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 LABREE AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2019
Mailing Address - Country:US
Mailing Address - Phone:218-681-4506
Mailing Address - Fax:218-681-1113
Practice Address - Street 1:321 LABREE AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2019
Practice Address - Country:US
Practice Address - Phone:218-681-4506
Practice Address - Fax:218-681-1113
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8126124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist