Provider Demographics
NPI:1972739910
Name:CANNICK, GABRIELLE FERGUSON (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:FERGUSON
Last Name:CANNICK
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 LIBERTY HWY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1229
Mailing Address - Country:US
Mailing Address - Phone:864-224-0809
Mailing Address - Fax:864-224-0811
Practice Address - Street 1:3905 LIBERTY HWY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1229
Practice Address - Country:US
Practice Address - Phone:864-224-0809
Practice Address - Fax:864-224-0811
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice