Provider Demographics
NPI:1205305000
Name:KARUN GABA DMD LLC
Entity type:Organization
Organization Name:KARUN GABA DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GABA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-399-9663
Mailing Address - Street 1:15288 W BROOKSIDE LN STE 131
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3990
Mailing Address - Country:US
Mailing Address - Phone:623-251-4346
Mailing Address - Fax:623-251-4767
Practice Address - Street 1:10320 W MCDOWELL RD STE A1001
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4865
Practice Address - Country:US
Practice Address - Phone:623-242-6001
Practice Address - Fax:623-242-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ560706Medicaid