Provider Demographics
NPI:1982836813
Name:GABRIELSEN, ERIC J (DDS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:GABRIELSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BRIDGE ST.
Mailing Address - Street 2:STE-100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:713-843-9800
Mailing Address - Fax:715-843-9819
Practice Address - Street 1:200 E. BRIDGE ST.
Practice Address - Street 2:STE-100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:713-843-9800
Practice Address - Fax:715-843-9819
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6445-151223G0001X
WI6445-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice